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LEOPOLD and LOEB 


A PSYCHIATRIC — PSYCHOLOGICAL 
STUDY 


by 
MAURICE URSTEIN 


New York, 1924 
LECOUVER PRESS COMPANY 
PRINTERS 
Firry-ONE VESEY STREET 





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HE daily papers have rarely been so eagerly devoured 

by their readers as at the time of the Leopold-Loeb case. 

From the very first, public interest was concentrated 

on the doers of the deed, and we caught a glimpse of 

the same pictures that sensational court proceedings contribute to 

the kaleidoscope of life; feelings of horror, prejudices, thirst for 

revenge, sober judgment, a sense of justice, and objectiveness 
mix themselves together. 

It must be granted, however, that the act which created a 
stir far beyond this country is so frightful, psychologically so 
incomprehensible, so singular in its unfoldment that, if a Poe 
or a writer of detective stories wished to unnerve his readers, 
no better tale could be invented, no knot harder to unravel; 
no events could follow each other more effectively than life, or 
rather disease, has here woven them together. 

This is the reason why the Leopold-Loeb case has unrolled 
once again for every psychiatrist the whole mass of psychological 
problems; and now, after the first storm of indignation has some- 
what abated, it is his duty to raise his voice to show the abnormal- 
ities of the case and to point out the offshoots. 

Not one of us would be surprised if a child whose parents 
are criminals or who has been reared in an atmosphere of crime 
were to become an enemy of society, a law-breaker, an offender. 
it is also clear that a child who has grown up in such wicked 
society, a child showing evil tendencies, can still become a worthy 
member of a community if placed in favorable surroundings and 
given an appropriate education. On the other hand, we are 
astonished and forced to serious reflection when a child subjected 
to the best influences becomes a criminal. In such an instance, 
every one is inclined to suppose, and the psychiatrist is justified 
in asserting, that the cause lies in the very personality of the 
individual and must surely be attributed to a pathological condi- 
tion of his mental qualities. 

Because of this, we have to examine the psyche of such an 
individual from every angle to do him justice and give him the 
square deal to which he is entitled. Even though the details of 
the case make us shudder, in spite of the sympathy felt for the 
grief-stricken parents of the innocent victim, we must still judge 
"? 


=~ 


2 


calmly, weighing the facts objectively and carefully, mastering 
any trace of emotion. 

A judge must never be cruel—only severe—but just. We 
know full well that a terrible deed has been committed and ex- 
piation is demanded. We know that within society there is no 
place for such persons. We know they are very dangerous. We 
know that the community must be protected from those individu- 
als. And yet, despite all this, it would be against our ethical sensi- 
bility were we to treat as a criminal and to punish someone whose 
_ ordinary reasons and controls are lacking, or anybody who acts 
under abnormal motives caused by disturbed mental disposition. 

We believe these boys were in an irresponsible condition due 
to a failure of their emotion, will, and thinking power. This 
fact, which a psychiatrist could have proved again and again, 
does not at all exclude the apparent deliberation and carrying out | 
of a carefully prepared plan of action. r 

It seems a priori unbelievable that these boys were conscious © 
of the full import of their actions. They could not picture the 
future; were unable to anticipate the consequences: to see them- } 
selves in the glory of youth sent to the gallows, to prison for life, - 
or to an insane asylum—an unavoidable condition that no 
Schopenhauer, Nietzsche, Aretino, or Cellini* could make more _ 
endurable; nor were they able to visualize their parents with 
their life happiness so ruthlessly destroyed through the sons for 
whom they entertained such high hopes. 

If these boys of respected families, the spoiled children of 
millionaires, succumbed to the pessimistic, antisocial philosophy 
of a Schopenhauer, a Hartmann, or a Cellini, it is only because 
their power of judgment was lost in the early stages of their life, 
and as slaves of the demon that overmastered them, they were 
unable to understand these teachings and to make them harmless 
with the force of a healthy mind. 

Had these students of jurisprudence, victims of an early moral 
shipwreck, been able to realize the far-reaching consequences of 
their actions, they would have refrained from them; not only 
as future lawyers, but also as followers of Schopenhauer and 
Hartmann. These tywo_philosophers, though despising mankind, 
had a higher regard for the life of an individual than many other 





* The boys are said to have been influenced by ideas of these men. 


Ay 


3 


friends of society. In fact, Schopenhauer respected the life even of 
an animal to such an extent that he rejoiced over the introduction of 
railroads because it made the existence of hundreds of thousands 
of horses more bearable. And this same Hartmann, who taught 
that humanity is less happy the more consciously and forcibly 
it develops itself, fought vegetarianism most aggressively, as, in 
his opinion, it did not afford the body sufficient nourishment. 

On this account, we do not wish to hold any philosopher 
responsible if his readers draw wrong conclusions, and we can- 
not attribute the corruption of youth to the misunderstood teach- 
ings of Schopenhauer-Nietzsche cr to the entire modern tendency 
of thought. We can refrain from laying the blame at the door 
of society, and will not accuse our times, unsuitable family life, 
purposeless education, or irreligiousness; nor do we desire to 
put on spectacles colored by personal opinions in reviewing the 
case or in giving it sensational headlines; neither do we wish to 
regard it from the standpoint of the wealth or poverty of the 
classes of society to which these boys belong. 

Furthermore, we will not quote Lombroso, whose arguments 
have long been disproved; but we must penetrate only and solely 
the secret recesses of the sick human soul. 

Even normal life shows millions of forms and variations; 
as Bentzel-Sternau so crassly expresses it, “The mixture called 
man is the wildest ragout that ever escaped from a cookbook.” 
How much more puzzling is the shattered psyche, and into 
what unaccountable forms does it shape itself! 

If we wish to arrive, however, at a just opinion of a certain 
person, his entire life, and not merely particular stages of it, 
must be carefully studied. It is not enough to observe or to 
describe how somebody acts during a distinct period of time or 
in the course of a ntmber of interviews. This is the very reason 
that frequently wrong impressions arise in people in regard to 
psychic conditions in others, when they note that, in a given case, 
the person, acting rationally under the influence of a particular 
condition, seemingly discussed essentials, spoke to the point, and 
cleverly defended himself without manifesting on the surface 
a trace of disease. All of these qualities can doubtless be present 
at a given moment—still, this does not in the slightest degree 
prove that such capacities suffice for a right way of living, nor 


4 


that the person is normal from a psychiatric standpoint, and 
responsible for his actions. 

In any case, this ought to prove that it is absolutely essential 
thoroughly to know the psyche of such an individual. But he 
who has not had sufficient personal experience in this field and 
is not familiar with the manifold clinical phenomena from which 
he is entitled to make valid statements, such a person must at 
least possess a complete record that goes back to earliest child- 
hood and give an opinion only on the basis of a careful investiga- 
tion of the individual’s whole life. 

Should we, however, with the knowledge of an expert have 
succeeded in obtaining an insight into each detail of the life 
of an abnormal person, if we were able to weigh everything 
accurately and have adjudged it at its true worth, we can repeat 
what the noted psychiatrist and psychologist, Koch, said as far 
back as 1888: “In this manner, many an unsuspected glimpse is 
gained into the life of people and the motives actuating them. 
We supply ourselves with the key to the correlations of human 
activity which is obtainable in no other way. We begin to 
recognize that many a thing is not so bad, another not so good, as 
it seems to be. We conceive why genial disposition and weakness 
are often so strangely mixed. We become sympathetic and ready 
to be helpful in cases we would possibly pass by with a shrug, 
if not with pharisaical haughtiness; and then, as physicians, we 
become friends and helpers to those patients from whom we 
were formerly repelled, or at any rate, whom we were not ready 
to serve. We are also able to give the judge and the clergyman 
points of contact which may become a blessing, and which will 
further fairness and justice.” 

How, therefore, did the former life of these boys picture 
itself in our mind, of youths from the better class of society, who 
in all coldness and deliberation took a human lite and tried par-— par- > 
tially to justify 1 this by_ regarding it also as a a kind of d of scientific” 
experiment ? Waka eae 

What name shall we give a man who does ‘hot at once” dis- 
ihre stop at a RR Gate the body j in the car, and. eat heartily 
to appease his hunger? Later, on reaching his house, he finds 
visitors and drives them to their homes. After that, he spends 


5 


his time playing cards, and then retires as if his conscience were 
perfectly clear and the softest pillow. A few days later, with 
no trace of regret, he betakes himself to the university, where 
he passes his examinations with “flying colors.” 

What sort of a person is this who confesses his deed with 
hair-splitting exactitude, showing no sign of excitement, living 
over the details of the delict with no mark of collapse? 

How shall we regard some one who asserts—and we can 
believe him, for in that moment it is his firm conviction, as it 
fits his personality and mode of thinking—that he would prefer 
to be adjudged normal and responsible for a deed which a well 
man would have to expiate with death, rather than to be con- 
sidered insane? 

What does our psychiatric experience prove in regard to an 
individual who considers himself beyond justice and mankind, 
claiming immunity; for he looks upon himself as in a class of his 
own, and believes he may pierce human hearts with the cold- 
bloodedness with which he would impale butterflies ? 

How does it happen, and among what kind of individuals do 
we usually note that they are readily influenced, and, like children, 
can be persuaded to be drawn into anything? 

These problems will be solved when the results of our recent 
research have been objectively noted. Let us confine ourselves 
to the domain of the expert to show to what degree feeling, 
thought, and action are influenced by mental disturbances, and 
we will try to set forth our opinions so that they can be gen- 
erally understood. 

First of all, we must determine whether these boys, though 
their behavior was more or less entirely orderly, their actions in 
line with their thoughts and aims, still do not reveal to the expert 
psychic abnormities_ as cause of their criminality, despite the 
fact that they appeared seemingly normal and healthy to a lay- 
man’s eye. It must therefore be investigated whether these 
boys at present show pathological signs or manifested morbid 
symptoms at an earlier period. If so, we will decide what in- 
fluence these psychic changes had or were bound to have on their 
later behavior. This proof must apply especially to those actions 
which led to the interference of the court. 

We do not fail to recognize the difficulties to be overcome, 


6 


the more so as we agree with the famous court expert Bischoff,** 
who says in his textbook of legal psychiatry: “It does happen that 
without psychiatric experience a judge gets often an altogether 
false impression of the person under observation. He usually 
takes a much too onesided view of feats of memory, fails to 
recognize defects of independent judgment, and disregards en- 
tirely serious disturbances of actions that are often present in 
spite of good intellectual accomplishments. Nor does the judge 
always know the great influence of emotional disturbances on the 
ability to perform an action. In certain forms of mental disease, 
it is quite impossible to make clear to the layman how strong 
the influence of morbid psychic processes is upon the whole 
mental activity.” 

Furthermore, we must keep in mind that but very little value 
is to be placed on the utterances of such persons. Being in 
possession of their reasoning faculties, they are not at a loss for 
words. What these persons forfeit early is the normal emphasis 
of feelings, the lack of which cannot be noticed in conversation. 
On the other hand, even less pronounced disturbance in feeling 
and reacting, when perceived as such, puts one on the right track 
and allows one to.judge the psychic condition much better than 
by spoken words. “It cannot be emphasized too strongly that 
the correct understanding of a person’s mental disposition is to 
be taken only from his actions.” ‘ 

The initiative for actions results from perceptions, feelings, 
or moods and not from intellectual capacities. If we wish to 
understand and to judge correctly an individual’s actions, we 
must investigate the condition of his emotions, which are the 
most important attributes of our soul. These appear as an in- 
dependent process and are essential for the understanding of 
psychic abnormities. | 

Three kinds of emotions accompany our conceptions : the ral, 
which are expressed by the pleasure in the good and the na 
horrence of evil; the aesthetic, which develop our sense of beauty ; 
and the logigal, which affirm the truth and refute what is false. 
The totality of our intellectual performances we know as reason. 
The latter has nothing to do with the efficacy of emotions and 
passions. On the other hand, emotions and passions exert an 
enormous influence on every action and must absolutely be taken 

TAR 


7 


into consideration when we have to examine punishable deeds. 
It is therefore important that the condition of unaccountability 
does not mean lack of reason but abolition of its use. Because 
through this it is possible to assert that, even when reason is 
intact, its use may be arrested through emotional diseases or 
pathological affects. 

We know also from our clinical experience that in many 
morbid states the moral and aesthetic feelings are lost at a time 
when the intellect does not yet show any defects. Some psychi- 
atrists maintain, however, that a careful investigation may es- 
tablish intellectual disturbances even in cases of moral depravity; 
still, as there are many people with but little intellectual de- - 
velopment, who possess the highest ethical qualities, we must 
conclude that defects in the domain of the emotional life really 
occur independently, and that just these defects often cause 
criminality. 

This moral deficiency is strongly marked by sensual mani- 
festations and inclinations. Under normal conditions, the latter 
are kept down and inhibited by higher feelings. .When, however, 
this restraint is absent, the lower egotistical impulses are set © 
free and constantly urge to be appeased. 

Emotional life and mood are therefore dependent on percep- 
tions and feelings. Every conscious sensation—being for us 
a pleasurable or unpleasant impression—leaves behind a distinct 
memory picture. The sum of the impressions—rather, memory 
pictures—of our mental or physical ego determines what we 
call self-consciousness. On this depends the stability as well as 
the responsibility of all mental processes of a normal individual. 
Every perception, every idea, under normal conditions relates 
itself at once in one’s self-consciousness and through this re- 
ceives its emotional emphasis. 

First and foremost the moral emotional life is altered in 
a psychosis named catatoma, from which, as we shall see, the 
Chicago boys also suffer. This disease means the disappearance 


of the regulating feelings growing out of the consciousness. of 


the personality; catatonia causes a gradual devastation of ethical 
ideas and_principles, undermines the whole being, and relentlessly 


drives it to its moral overthrow. 
Our description of the nature and the clinical manifestations 


8 


of catatonia, the symptomatology of which will reflect Leopold 
and Loeb with photographic precision, may further prove why 
we cannot bring our case in connection with a psychopathic de- 
generation or moral insanity, but must regard the Chicago boys 
as catatonics, that means, insane_persons. 

We will further show that the actions of such persons very 
often become entirely unaccountable, unmotivated, are in most 
cases just the opposite of their former nature, do not harmonize 
with the situation. 

From the above brief statements, it is clear what we have 
to consider in the investigation of such cases, and from what 
point of view we must be guided in forming an opinion. From 
this we also determine the direction and way in which we are 
to proceed in order to arrive at a right goal; and we shall have 
to present first the symptomatology of catatonia in the compass 
demanded by our cases. 


MAURICE URSTEIN 
WARSAW 
Temporarily in the United States 


New York, June 22, 1924. 


9 


Since the chains of superstition and belief in witchcraft have 
been stricken off, and insanity is no longer regarded as posses- 
sion by the devil, who can be driven out by exorcism and prayer, 
it has become more and more recognized that mental disease is 
the expression of disturbed function of the central nervous 
organ, namely, the brain. Psychiatry progressed to a special 
branch of medicine, but it fell at once under teleological and 
moral-philosophical domination. When it had rid itself of these 
influences, psychiatry, like every other clinical branch at its 
beginning, developed in such a way that, of the manifold patho- 
logical forms which experience brought, it selected for recogni- 
tion and diagnosis the most striking symptoms of disorder and 
emphasized as characteristics and as terms those signs which 
stood forth most clearly, even such as would attract the attention 
of the laity. 

The general practitioner also formerly understood as diseases 
what today are only symptoms to him—let us recall, for instance, 
chills, fever, jaundice, and dropsy. Thus, too, specialists in 
mental disturbances designated diseases even up to thirty years 
ago—and the psychiatrists who do not keep pace with the de- 
velopment of this branch of knowledge but remain in the old 
traditions still diagnose also today—according to the signs which 
were prominent clinically. | Psychiatry was indeed a purely 
symptomatic system. It knew only transitory pictures, but no 
morbid processes; it did not sufficiently distinguish conditions 
from clinical umties. 

“Whoever showed excitement or fury, had a mania ;* he who 
was sad and depressed, has been called a melancholic ;+ a person 
that gave the impression of being disoriented and confused suf- 
fered from amentia;t while every psychosis with delusions or 
hallucinations was diagnosed as paranoia,$ without the possibility 
of foretelling what awaited the patient in the future. Even the 





* The Greek word mania means in English fury. 

+ Melancholia means black gall, because some thousands of years ago 
sorrowful states were connected with the liver. 

tAmentia means in English mental disturbance. 

§ Para means near, just beyond, beside; noia means mind, so that the 
hyperclever medical term paranoia means just beyond or beside the mind. 
The German word for paranoia is Verruecktheit and means that the mind 
is “pushed out of line.” 


10 


experienced clinician could say no more than this: that many 
forms of insanity pass on to cure; others recur periodically or 
fall into a chronic state; that frequently after depression a phase 
of exaltation appears or the opposite; that, further, with many 
patients after the first psychic attack, there sets in a condition 
of mental weakness or grave deterioration which—if already evi- 
dent to all people—was termed ‘secondary dementia’; while 
other patients, even after many returns of the disorder, give 
evidence of no emotional or intellectual injury. But no one of 
the alienists knew upon what this or that outcome depended, 
and it was difficult to establish any prognosis. 

“First Kraepelin, to whom Kahlbaum and Hecker had already 
shown and, in part, even opened the right way, taught us to 
obtain a deeper insight in the relationship of different, similar, or 
identical manifestations; whereby he set forth distinct psychic 
forms of disease, that means, pathological entities, which could be 
sharply distinguished from one another in regard to symptomat- 
ology, course, and outcome.” : 

It is not possible to show here the enormous value which 
the work of Kraepelin and his followers had at that time for 
the advance of psychiatry. We will merely discuss the charac- 
teristic marks of two forms of disease, namely, dementia praecox 
and psychopathy, in order to decide into which group we must 
put the cases of Leopold and Loeb. 

“Dementia _praecox, that means, precocious deterioration, be- 
longs to the so-called functional psychoses, theretore to those in 
which we have not yet been and where we may never be success- 
ful in demonstrating in the brain constant changes of a causal 
nature. For reasons fully discussed in my monographs, I iden- 
tify dementia praecox with Kahlbaum’s much more suitable 
designation, catatonia, that means, insanity with tension, while 
Hecker spoke of hebephrenia, juvenile insanity, Wernicke, and 
even more Gross, proposed the name dementia sejunctiva, that 
means, deterioration resulting from splitting, and Bleuler used 
the term shizophrenia, which expresses splitting insanity. 

But, whatever name we may give to this psychosis, any 
modern alienist sees in it an illness in which little by little a total 


° . . one . ' 
dissol entire mental personality comes to pass, above 
ent be : 


all, a gradual devastation in the territory of the emotional life. 
RT RNENE a egee Tear wage 


11 

) “Memory, power_of observation, and the ability to under- 
stand everything that the patient hears going on in his environ- 
‘ment may have suffered little or not at all, even in the end 
stages of the sicknéss. Yet such an individual, in the ‘very onset 
of the disease, manifests impairment of the harmonious connec- 
tion between the various psychic functions and processes. This 
‘shows itself in loss of critical judgment, in failure of logical 
association of ideas, in lack of sequence in drawing conclusions. 
The patient, furthermore, becomes totally indifferent in every 
Tespect, loses his independence, is childish. As time goes on, 
there appear insane ideas and hallucinations, also strange traits, 
as well as peculiarities of all sorts. These, to be sure, are already 
present in very many cases long before acute symptoms become 
evident. Catalepsy (increasing pliancy),* muscular” tensions, 
automatic obedience, negativism, stereotypy in action, mannerism, 
mimicry in speech and movement, are among the constant signs, 


“As a tule, the outbreak of the psychosis, which may have 
been preceded for years or decades by symptoms that are inter. 
preted as neurasthenic, hysterical, hypochondriacal, is marked 
by feelings of distress, by sadness and depression. Then 
it passes over into the stage of apathy or excitement, during 
which the following symptoms add themselves to those already 
mentioned: purposelessness and monotony of movement: repeti- 
tion of the same sentences or words; pathetic, theatrical man- 
ner ; impulsive actions, until, sooner or later, a more or less pro- 
nounced psychic defect or total mental weakness is established. 


“Various modifications often appear in the course of the 
disease. The psychosis at first may develop unnoticed or in mild 
onslaughts. Other patients reveal in the periods between at- 
tacks, as a residuum of the grave illness, an alteration of their 
former nature or more obvious defects and signs of a dissolution 
of their personality. 


“The existence of analagous clinical symptoms and phases 
in catatonia, as well as in other psychoses, has led us to analyze 
more in detail the individual signs of the disease; to separate 
them into their constituent elements; more sharply to define their 
strength and formation; to discover in the conditions as such 





*That is, loss of resistance toward passive movements. 


12 


distinguishing marks and to weigh them accordingly. Thus, to- 
day, almost without exception, we are able to recognize to which 
pathological entity a given symptom or state belongs. 

“If, for example, confusion arises in catatonics, this is only 
an apparent one. The patient himself remains completely con- 
trolled even in the most elementary states of excitement and is 
able to account to himself for everything. The catatonic, _more- 
over, is not hindered or impeded in_his ‘speech, “actions, _and 
movements, but obstructed, blocked, bound. | If there te an 
of the negativism, an action in the jupuae ‘lenge a counter- 
action, which inhibits the carrying out of the purpose. For this 
reason, the patient, for example, stretches out the hand in greet- 
ing, but draws it back before it has reached the object. Or we 
see that he makes the initial lip movements in response to a 
question, but almost at the same time closes the mouth tightly. 
Or he is suddenly stopped in his speech and cannot be moved to 
continue or he is able to go on only after a while. 

“The points of view here discussed have been elaborated in 
no small degree in the course of time. After having worked for 
ten years in various university clinics, private and public institu- 
tions, | assembled a material on the basis of which, already in 
my monograph * appearing in 1909, it could be shown to what 
symptoms and morbid states particular value is to be attributed 
for the purpose of differential diagnosis. ‘ 

“After the publication of this last-mentioned work, I occupied 
myself again very intensively with the problem of the functional 
psychoses, and it was granted to me among others to build fur- 
ther upon the entire material of Laehr,y+ that master of clinical 
psychiatry and distinguished consultant. From this I obtained 
thousands of histories, which certainly may be called the best, 
qualitatively the most elective, and very well fitted to solve the 
manifold problems. Sixty years of untiring, determined, extra- 
ordinarily productive work had been required for the accumula- 
tion of the material, unique of its kind! On this ground it must 
be unreservedly stated that we shall never again find such an 
immense number of journals, so rich in content, so complete in 





+ Laehr was the founder of one of the most superior, beneficent, and 
“s, humane sanitariums I have ever seen. 





13 


the life records of the patients; and no case histories can be 
collected that permit a more exact survey over an equally long 
period of time! 

“A great value of this material lies in the fact that the case 
histories, which are merely descriptive, registering in objective 
manner the clinical manifestations obtained from the patients 
without any expression of opinion, were made for many de- 
cades by one and the same alienist. These observers were thus 
no psychiatric novices, as is usually the case in state or com- 
munity institutions, nor were they self-taught men, but schooled 
clinicians,t who, since they had known their patients from the 
beginning of the disorder on, would have been struck by every 
change in their condition. Furthermore, the same interest had 
been brought to the entirely chronic cases as to the acute ones, 
for which reason, the journals from beginning to end are uni- 
form and clear in content. Besides, the patient as an individual 
is represented as an unified whole; in the anamnesis always his 
character, temperament, and every event worthy of mention up 
to the outbreak of his illness are set down, so that the slightest 
deviations which have to be referred to the psychosis can be at 
once made evident. 
“The material that justified me in drawing a train of con- 
clusions is, therefore, not only in reference to the length of 
time of the observations, the longest studied, but quantitatively also 
it is incomparably richer than any other that up to this time 
has been utilized for similar purposes. Thus I investigated some 
dozens of patients who had remained in the institution for fifty 
years and more. I saw hundreds of patients in whom the psy- 
chosis had run for years and decades under the picture of 
hysteria, psychopathy, or some other form of mental disease 
regarded as curable, until it had taken on a malignant character 
leading to terminal catatonic deterioration. I learned to know 
individuals, who, after a free interval of thirty years, because 
of a relapse, had to be brought again to the institution, where 
they then quickly passed into typical dementia. I saw, likewise, 
a series of patients in whom, not earlier than after ten to 


oe 





‘+1 mention here, beside Laehr’s entire material, numerous case his- 
tories prepared by Kahlibaum, Hecker, Ziehen, Wernicke, Moeli, Siemerling, 
Aschaffenburg, which were also elaborated. 


14 


twelve attacks of the psychosis, recurring at rather long intervals, 
a complete disintegration of the personality had taken place. 

“The value of the records was essentially increased through 
the fact that Laehr’s material almost entirely concerned persons 
who belonged to the better, often the best social circles and be- 
cause of their culture as well as intelligence gave very good 
information about their pathological ideas, tendencies, and im- 
pulses, being able to reproduce minutely, in speech or in writing, 
their abnormal psychic condition, the inner conflicts, and so forth. 
On the other hand, just in such individuals was it especially easy 
to study the weakening of the various psychic functions, the loss 
and defect, the decline of the emotional balance, the fragments 
which remained of the former sound personality, as well as the 
gradual sinking down the social ladder, which, as our cases 
teach us, may first become manifest to the laity after twenty, 
thirty, or more years. It is true that even highly cultured in. 
dividuals also deteriorate sometimes quite rapidly and in charac- 
teristic catatonic manner; for, aside from the personality of the 
patient, heredity, disposition, age, environment, enter into the 
situation. The mental aristocrats also become dead as regards 
the world about them, or at least their own circle, in which 
every abnormality, however small, becomes evident, making inter 
course and life together more difficult; but, generally speaking, 
here, even in the advanced stages of the psychosis, we may never 
expect such pictures as are observed in patients of state and com- 
munity institutions. 

“Just as there is a difference in the symptomatology and the 
course of the psychosis in culturally low individuals and people 
with a common school education—the details which show this are 
published in my papers on comparative psychiatry * *—so also 
there exist differences between the last-named and those of a 
higher, respectively, moderate intellectual endowment. On these 
grounds we see retained in catatonics of high cultural grades, after 
an illness of long standing, alertness, independence, participation in 
the environment, or other qualities, often to a degree which in those 
mentally but little or moderately developed would not be manifest 
even in their normal condition. Moreover, also inicases which 
may be considered as terminal states of catatonia, individual 
tendencies are present, habits from the days of health. We find 





15 


echoes of earlier happy times, just exactly as in officers of higher 
rank often in far-advanced stages of general paresis we see pre- 
served discipline, posture, subordination, and the like.’ 


¥ “Here also, as has been emphasized in earlier works, must 
be noted the astonishingly great capacity of catatonics to be in- 
fluenced by their environment, their ability to adapt to all con- 
ditions of life, and the possibility of educating them. It was 
precisely the study of Laehr’s patients which strengthened me 
still more in my opinion that similarly we can train catatonics to 
physical work—we know, for example, that institutional inmates 
in whom the intellectual sphere is totally crippled count among 
the very best working forces—in the same manner it is possible 
also to incite intellectually prominent individuals to psychic ac- 
tivity, to save a part of what they formerly possessed. The 
patients can be brought to the point where they will read and also 
to talk about what they read; to follow and discuss the day’s 
events ; to take part in lectures and social entertainments; and so 
to deport themselves outwardly that at first nothing abnormal is 
noticed. 

¢ “An investigation could be made in this institution of many 
patients also who, though they presented various catatonic symp- 
toms and had been for a long time full of delusional ideas, behaved 
themselves quietly and in good order. They could be drawn into 
everything, so that they observed with interest what went on 
about them, were friendly, always came to the lectures, took part 
in social gatherings, and were favorably diverted by stimuli from 
-without—all, to be sure, so long as they were not disturbed in their 
customary, smoothly regulated pursuits, were kept far from every 
source of excitement, and their peculiarities respected. Through 
some dozens of minutely reported cases, we have to show in this 
monograph ® what was preserved and could be demonstrated in 
catatonics after decades of this illness. 


“Tt is also to be noted that we must not spin out too subtilely 
the various symptoms of a disease nor construct too much out 
of them. We have to omit in general all theoretical speculations. 
Furthermore, for the deduction of facts and concepts, just as 
for conclusions, only clear typical cases and solely entire life 
histories must be used. In the setting up of disease groups, we 
have to consider each class of society by itself. The mistaken 


16 


conceptions of many psychiatrists as to what is catatonia and 
what is psychopathy must to a great extent be at- 
tributed to the fact that up till now predominantly clinical and 
institutional material has been utilized for study of the subject. 
Definite findings have been generalized which fit the case of 
average catatonics or those but little developed mentally, while 
in patients of high intellectual standing, the same statements are 
delusive. If a psychiatrist, on the basis of knowledge he might 
be able to obtain from decades of devoted study in asylums, should 
examine the cases in the upper circles of society and give his 
Opinion upon the intellectual aristocrats, he will be led to believe 
that he has to do with psychoses of another kind. And yet they 
are identical, differing only in various qualitative irregularities. 
They have been banished from sight for years and decades merely 
because the correct standard was not applied to them from the 
onset. 

“It is important also to keep before us the continuity in the 
development of the disease and not to efface the complete clinical 
picture. Frequently it does not matter what the patient brings 
to expression, but how he does it. An idea or an action, in case 
it is constantly repeated, may take on the character of a stereotypy, 
which, indeed, is a distinguishing mark of catatonia; exactly as 
a, sentence spoken at first with the appropriate affect, if it were 
repeated again and again, would in time pass over into a mechan- 
ical, lamentable pathos. | 

“Of course, it is not difficult to make a correct diagnosis after 
a certain number of years or decades if we have the patient before 
us in a more or less deteriorated condition. The question is 
whether already in the beginning of the psychosis we are in the 
position to define the latter as a process leading to dementia. This 
has been answered affirmatively in my first papers,* > and I have 
not changed my standpoint since then. Studies in the last years 
have only brought countless proofs of the correctness of my 
former conclusions and facts that fill out experiences which were | 
forced upon me already from the analysis of the first two thousand 
appropriate cases of catatonia. Therefore, today, it will no longer 
be difficult in a given patient, even in the earliest stages of his 
disease, to demonstrate those symptoms on the basis of which a 





14 


diagnosis must already be established at a time when evident symp- 
toms of catatonia have not yet manifested themselves.”* 

Yet, before we can determine the disease from which Leopold 
and Loeb are suffering and justify our diagnosis, we must en- 
large upon the symptomatology of catatonia, especially of those - 
groups that proceed under the form of the psychopathies, and to 
which we have devoted a special monograph.** We shall find 
in the following descriptions all traits which characterize the per- 
sonalities of the two Chicago boys. 

ze A relatively frequent phenomenon, especially 1 in the beginning 


eee 


of catatonia, is the heightened f feeling of the ego, with exalted 
self-consciousness. The patients show limitless self-conceit, are 
puffed-out in behavior, demonstrative in manner. They consider 
themselves highly intelligent, philosophical experts, as especially 
interesting cases. They are boastful, greatly overestimate their 
ability, accomplishments, and capacities; they know best about 
everything, and alas for him who merely casts doubt upon them! 
They manifest a many-sided but always superficial interest; start 
all things, but finish none. They try to color their doings and 
dealings, to refute ideas contrary to theirs by dialectic subtleties, 
to justify their wishes by all the means which the art of per- 
suasion can furnish them. They persist in their excuses, are 
never disconcerted, insist dogmatically on their point of view. 
They speak in a didactic tone and are always giving good advice; 
they like to act as mentors to others, interfere in their affairs; 
they get mixed up with everything; they even consider that they 
have the right to discipline or to maltreat others. 

~Many show an affected manner, a forced demeanor, and _ fall 
into theatrical excitement. They _ are great talkers, exalted, pa- 
thetic, ask of themselves to Be placed in cells for the raving in 
order to report their impressions in their memoirs. They seek to 
be in the foreground, to bring their persons to attention, to make 
themselves interesting in conversation, or to have the say in 
games. They soon obtain control of their environment, want to 
bring forward their information upon every occasion, press their 
opinions upon others; they wish above everything always to have 
their high intellectual traits recognized; they seek everywhere to 
assume an exceptional attitude. 


_ * Abstracts from the monograph * and the papers.®: * 


18 


% “Others are disputatious, ill-tempered, quarrelsome, pug- 
nacious, malicious, disrespectful; they stir up strife, hatch out 
plots together, intrigue, try to arouse dissatisfaction everywhere. 
Many of them behave as arrogantly as possible in the institution— 
which they call the morgue, madhouse, mousetrap, dog kennel, 
house of correction, brothel. They betray a certain superior 
manner; know the forms of society; have always thought of 
something better they might be; are too good for common work; 
too distinguished for association with ordinary people, upon 
whom they look down with scorn and contempt. They are 
irascible, insolent, inclined to excessive affective discharge. They 
become cynical, violent, brutal, especially toward those who are 
weaker, while they submit to ill-treatment by those who are 
stronger. 

“There is often a tendency to lying and cheating, although it 
is difficult to determine whether we have to do with lack of faith- 
fulness in reproduction or with conscious invention. Yet it must 
be admitted that the cheating arises not seldom from an inner 
compulsion, for the patients lie even where it is of no service. 
Some of them, accustomed to lying and stealing for years, have 
fabricated long stories merely for the sake of talking. Of one 
patient (Case III) we read: ‘Lies and deceives cunningly. AlI- 
ways very artful and hypocritical. Seeks under the most varied 
excuses to force her way into another’s room. Likes to play 
cards or chess, but cheats and is very angry if accused of it. Is 
always nibbling whatever she can find about. Puts into her pocket 
everything she can reach. Very skillful about it; hurt if caught. 
Always has an excuse, explanation, or falsehood at hand at once. 
Does everything with a completely innocent expression.’ 

“Many falsify the physician’s orders according to their own 
wishes. They recount freely invented conversations. They dis- 
tort facts, glibly deny their actions even in the face of direct 
evidence and statements which they themselves have made. Often, 
they will confess afterwards that they told something that did not 
entirely rest upon fact, that they have, of course, purposely mis- 
represented different things. 

“Not less frequent are fabrications, especially with regard to 
the institution and its personnel, often also against those very 
physicians who only a little while before were exalted to the 








19 


heavens. The patients are tireless in thinking up new complaints ; 
do not shrink from audacious distortions and the most atrocious 
insinuations. They also, by letter or during some visit of rela- 
tives, accuse those about them of the greatest crimes and tell 
the most frightful things. They box the ears of others and mis- 
treat them, but assert that they are the ones that have been struck. 
Indeed, the patients very often injure themselves in order after- 
wards to invent something about others: 

“Many patients maltreat themselves, wishing to attract atten- 
tion or to create a sensation. Besides, the accusations are very 
minutely depicted, so consistently and convincingly represented 
that, in a number of these cases, they have found full acceptance 
with very intelligent relatives, until investigations—sometimes 
legally undertaken by the institutions—brought to light the utter 
baselessness of the charges. 

“Tn other cases, self-accusations were made, much more fre- 
quently, however, confabulations and pseudological statements. 
It is not only that the patients think up complaints, intentionally 
deceive, purposely falsify, deck out their past in finest detail and 
with exaggeration to suit their personal needs. They even re- 
late attacks, allege that they have been assailed, and devise phan- 
tastic murder scenes. Other imagined attacks and occurrences are 
woven into the pictures. We read, for instance, in one record: 
‘Phantasy gained the upper hand and with it there appeared a 
tendency to self-deception, as well as falsehood to others.’ An- 
other time it is noted: “Decks out the tales while telling them 
and changes them readily. The confabulation accords with the 
questions that are put.’ One patient shows a very marked tendency 
to phantasy, spins out his fancies just as they occur to him, 
and invents assaults. 

“Simulation and voluntary deception are often observed. 
Catatonics shield themselves behind this or that excuse only in 
order to obtain something; they are triumphant afterwards, 
however, that they have secured what they were after. Some 
confess later that they had pretended, shammed, ‘simulated’ the 
fainting spells; ‘they themselves had caused’ the convulsions, had 
‘feigned’ one thing or another; that it would have been possible 
for them to have refrained from it all, to have controlled them- 
selves. 


7 


20 


“Many play with thoughts of self-destruction, threaten to 
commit suicide. Others ‘consciously’ behave theatrically, are in- 
tentionally incoherent in their speech, carry out foolish actions in 
a very deliberate manner, and, by their absurd answers, give the 
impression that they know what is correct. 

_ “Some patients show a marked talent for imitating their 
environment; caricature everything; are pert, ironical, sarcastic}; 
express themselves in a flippant manner; make sport of the 
peculiarities of their fellow-patients, finding amusement in them, 
and mimicking their speech, movements, and the like. 

“At times, excitement and angry outbursts are caused by ex- 
periences and ideas of the past. So, also, memories which arise 
may attain such force, reach such a high degree of semblance to 
reality, appear so vividly that they are perceived by the patients 
as actual. 

“Sometimes erotic or other trains of thought are spun out in 
phantastic form into dreamlike pictures, which the patients re- 
produce half as real occurrences, half as fabrications. Many set 
forth their dream experiences in detail, but it is difficult to say 
whether these are always true dreams since such persons not 
infrequently confuse dream and reality. Some of them sink into 
a dream state even while awake. 

“Many times they will recount superstitiously accepted coin- 
cidences and forebodings, use otttspoken symbolization, show 
fondness for dream and all sorts of other interpretations. 

“Some patients repeatedly affirm that they have had, even as 
little children, strange experiences, mysterious visions. It cannot 
be determined here whether or not these are falsifications of 
memory. 

“Not infrequently catatonics inject themselves into remini- 
scences full of emotions and see themselves in the most marvelous 
adventures. Many often picture, without a sign of fear, quite 
phantastic experiences, in which hell, torture chambers, hangmen, 
knives and blood play their part. 

“Often they are envious of every one, covet anything. Others 
appear quite nonchalant, try to cause embarrassment, speak un- 
‘concernedly in the presence of young persons of their sexual life, 
their love affairs, and so on. 

“Ability to remember and orientation, as in catatonia generally, 


21 


suffer also in these forms of the psychosis but little; yet it does 
happen that an obscure and very imperfect idea of many events 
remains. In isolated cases, apparent twilight states are precipi- 
tated through emotional experiences. 

“On the other hand, the self-possession of the catatonic must 
receive here special emphasis. In the midst of the wildest ex- 
citement or confusion, he takes notice of everything and after- 
wards knows how to report what happened about him. Often 
the patient surprises us by a well-ordered action or a witty re- 
mark. Not seldom, he suddenly begins to speak clearly, informs 
himself of everything, gives appropriate answers, but in the next 
moment falls again into his former confused condition. Or 
patients who lie apparently apathetic watch, however, especially 
if they believe themselves unobserved, most exactly over every- 
thing, yet without drawing any conclusions from it. Many oc- 
‘cupy themselves, but give up their work as soon as it is noticed 
by those about them. Or it happens that catatonics have lain for 
weeks without speaking or moving, when suddenly some morning 
they spring out of bed, converse in a friendly manner, seize a 
broom or mop, and take part in cleaning the hall. When the 
nurse comes to arrange the room, they begin to dust and—this is 
very typical for a catatonic—they wipe everything, furniture, 
dishes, and bedpan with the same cloth. 

“Many patients manifest a hair-splitting critical judgment, can 
give an exact report of their inner perceptions, dissect and analyze 
each feeling; they have explanations for everything. They at- 
tempt to justify what has happened, to excuse, to find reasons 
for; and they lose themselves in their auto-observation and self- 
criticism. Anomalies of the ideational life lead to delusional con- 
ceptions and interpretations of events. What takes place in the 
environment is often brought into relationship with themselves ; 
so that they become mistrustful, think themselves noticed, watched, 
finally, persecuted. 

“More than in my earlier studies, I must emphasize here the 
disharmonies, contrasts, and incongruences, in which, even at 
that time, I recognized the decisive diagnostic sign of catatonia. 
Closer investigation of such cases shows that this symptom is not 
absent, even at the very beginning of the disease; and I have, as a 
fact, in the last years never missed it in any patient. We have 





22 


to dg with—as I called it—an intrapsychic disharmony, an inner 
laceration, a Separation, a sejunction, cleavage and doubling or 
splitting of the personality, while the patient retains possession of 
himself and remains oriented. The bonds of association are 
destroyed; the thoughts slip from their paths, cross over one 
another. Consciousness is broken into fragments, the brain, as 
it were, subdivided into pieces, each of which works by itself 
without disturbing the others or influencing them. Everywhere 
the idea of a goal as a purpose is wanting; the formation and the 
carrying out of a logical conclusion are lacking. This loss of 
harmony, of unity, and of connection exists not only in relation 
to the adequate co-operation and interrelation of the manifold intra- 
psychic functions with one another but most especially also within 
the particular spheres themselves. From this result the grossest 
contradictions, the abruptness of ideas, the absence of affective 
depth of the suitable feeling tone.* 

“The above-described condition has been outlined by our 
patients with extraordinary clarity. So we read what a student 
says, referring to the time in which he feels better: “When I am 
in that state, and I have, for instance, to pack my things, I note 
how all the fifteen or twenty articles ought to be placed in the 
trunk; and I hold the picture in mind so that the work consists 
of the more mechanical arrangement. But, if I should pack now, 
when I feel ill, I must do my best to keep them together; and, 
having gathered three articles, I lose them if I take up a fourth.’ 
On another occasion this patient said: ‘When I’m feeling well, l 
seem to have a separate drawer in my brain for each idea; and, 
if I needed it, all I should have to do would be to open the 
drawer. Now that I’m ill, I am in doubt in which drawer a cer- 
tain idea belongs ; and, besides, the idea as such is hazy and unclear. 
I feel no lack of ideas: one disturbs the other. It’s just as if a 
lot of sheets of paper were piled on top of each other, and one 
couldn’t pull out the sheet one needed.’ 

“Another patient considers himself ‘mentally ill’ but not ‘ 





* We can compare the activity of the catatonic brain to an orchestra 
without a conductor; that is, to a musical organization in which each 
member works by himself with no concern for his partner. Thus, even 
if the orchestra performed a work together, also then there could be no 
harmony in it, because their instruments as such would bs mostly falsely 
tuned and must easily fail to accord. 


(| 








2d 


sane.’ In the former case, ‘it is a gradual letting down of mental 
functions, especially of the memory. In the case of insanity, 
however, the mind is still active, the ability to think is not dis- 
turbed, but the thoughts themselves lack logical coherence. One 
thought follows another, but they bear no relation to each other.’ 
“One patient said: ‘My mind is keenly alert, but I cannot act 
accordingly. I am too ill.’ 
“Another catatonic has ‘lost the harmony between will power, 
intellect, and soul freedom.’ 

“A patient says, ‘I have become two persons.’ Another, ‘I 
have lost a part of my head.’ 

“In one case, the patient has the feeling as if she ‘were split.’ 
She ‘relates this to the psyche and not to the bodily sphere.’ 

“A patient who has been ill for a long time says: ‘J’ai des 
sentiments dans moi qui ne correspondent pas (I have feelings 
that do not correspond )—then he suddenly halts and after a while 
adds, in German: Meinem uebrigen Wesen (with the rest of my 
being).’ A patient complains after years of sickness of intro- 
jections of other people’s ideas. The disturbances in his powers 
of thinking are regarded by him always as some strange experi- 
-ence. The schism in his personality grows clearer to him as he 
explains it.’ 

“One patient, when questioned why he suffered, answered, 
‘Because it’s as if I were divided into parts,’ and, being asked to 
explain this, said: ‘It’s as if there were two persons in me, I 
feel such inner discord. I’ve become a machine, without any 
will power of my own.’ 

We read of a catatonic, after ten years in an institution: 
“Little by little she haltingly states the following: At times she 
' does not know what to think of herself. On the whole, she is 
_kindly-disposed toward the psychiatrists—though she rails against 
| them in letters—but she lives as if she were a double ego: one 
person, A, and another person, B, exist in her. She has the 
feeling that someone is always standing behind her A-ego and 
nagging her on through whispers ; and because of this the B-ego is 
created. These two egos are constantly at war with each other. 
She cannot defend herself against these influences, much as she 
_would like to do so. For instance, she is unable to understand 
why she recently pounded for a whole hour with the cover of 


24 


the commode. Most of the letters were written by the B-ego.* 
Despite this, the patient cannot be convinced that she is ill, and 
she asserts that the psychiatrists produce in her everything with 
the aid of phonographs.”’ 

“Many catatonics perceive, frequently from a very definite 
point of time on, a sense of change that has taken place in them. 
They are no longer conscious of themselves, appear quite strange 
to themselves: as if they had lost their own personalities; as if 
it were no longer themselves with whom they had to do; as if 
other people were they. Sometimes the connection with the 
world and all that surrounds them has been lost. ‘I am not in 
these last weeks what I used to be,’ says a patient. ‘My mind was 
different before; I am no longer what I was,’ we read in one 
journal. ‘I am altogether some one else, have become another 
man. . . . It is exactly as if I were not at all like other living 
beings. I do not know what I am. I will soon be a human 
being no longer; they have made me into an animal.’ Once we 
read, ‘I cannot weep, and that proves the loss of emotions.’ An- 
other says, ‘I am totally turned to stone; I appear to myself so 
cold.’ Still another patient expresses it: ‘In my head all has be- 
come something else. When I look into the mirror, my face 
appears quite strange. Other people, even my relatives and 
acquaintances, now seem to me like entirely different persons.’ A 
patient complains: ‘I am not J, but once have been. I cannot 
remember anything more; I have experienced nothing. Certainly 
I remember dates out of my life, but it is just as if others were 
conversing about me. I see and also hear them all talking, but 
yet I hear nothing. My recollections lie outside myself.’ 

More evident still is the intrapsychic disharmony and the 
resulting disturbance between idea and feeling, as well as the 
marked disconnection between the various emotional centers, which 
is revealed in the letters of catatonics concerning whom we will 
speak later (page 97 and following). 

“At times, the peculiar fading of the memory pictures that 
should be reawakened is considered by the patients as weakness 
of their memory, although it can be made evident that the com- 
pleteness and faithfulness of the recollections have suffered no 
impairment. At other times, the feeling of the patient’s own 
body is completely lost. The individual seems to himself as an 


fies, 


automaton, like a statue. The perceptions find no echo within 
and, on this account, acquire no relationship to the patient’s own 
psychic life. This feeling of being a stranger, this depersonaliza- 
tion, which does not arise out of internal inhibitions but results 
from intrapsychic disharmony, manifests itself also in the fields 
of action and thinking. Action proceeds mechanically without 
consciousness of the will for it; the thoughts come and go without 
the individual’s participation. The patient seems to be an on- 
looker taking no part himself; he has no inner connection with 
his own perceptions or deeds, and he does not feel as an acting 
and suffering ego. He pictures to us his whole course of life 
as if he were a stranger standing outside. Often, he comments 
sarcastically upon his deeds, speaks of his states and his experi. 
ences with complete unconcern. At no given moment do they 
seem to have anything to do with him, and they are set forth 
without a sign that they rouse any personal feeling. Nothing 
would show that he himself stands in the midst of the picture. 
This absolute indifference toward his own person, which belongs 
among the very first symptoms of a beginning catatonia, can 
sometimes still be demonstrated in a very far-advanced stage of 
the disease. I will take as an example here a section from the 
record of our Case IX:*° ‘Reproduces all events with such faith- 
fulness as if they had taken place yesterday, and not fifteen years 
before. I must confess that I have not yet come upon a phenomenal 
memory of just this sort in patients in such advanced stages of 
catatonia. To be sure, if one did not interrupt the patient, she 
fell, a moment later, into a very confused drivel; yet, if one 
forced her, by interjecting frequent questions, to brief answers, 
it was possible to get all the details from her and, in fact—l 
repeat it—with a precision which was truly astonishing. She al- 
ways spoke impersonally, however, as if the matter had nothing 
to do with her. Even when the patient related stories concerning 
her family, she spoke only of a ‘woman Lachs (mother) and of 
a ‘gentleman brother.’ 

The lack of participation in one’s own history may be evident 
even in cases in which negativistic features predominate. In. 
structive in this connection is our Mrs. Tasch (Case XIX), who 
must pass as a most typical example of catatonia. 

“Tf one addressed the patient as ‘you’ or ‘Mrs. Tasch’ and 


26 


wanted to hear something about her life, she became gruff, re- 
fused to answer, and ran away. If asked, however—since the 

patient insisted that she was a man—‘Does Mr. Tasch know how - 
Mrs. Tasch escaped from the institution twenty years ago?’ or 

‘What can Mr. Tasch tell me of the former life of Mrs. Tasch?’ 

or, ‘Does Mr. Tasch remember what Mrs. Tasch said in the 
year 1890?’ or, ‘Could Mr. Tasch find out from Mrs. Tasch who : 
the doctors, nurses, and her fellow-patients were when she was_ 
in the Charité in 1886?’ the patient would tell without a trace of | 
affect about a Mrs. Tasch who, as she said, had lived a disgusting 
life—she was a prostitute. She spoke in the most shameless 
manner of the adventures of that Mrs. Tasch, how she enticed 
people to her in order to steal from them. ‘Thus she would con- : 
verse like a critic and an informant, as if about a total stranger 
to whom she was quite indifferent. I went with the patient over 
her entire life history and in this case, too, was verily astonished 

at the fabulous memory revealed in all respects. Literally every-_ 
thing that happened in the thirty-six years which the patient had 
spent in the institutions, as well as her previous life to the be- 

ginning of her illness, was pictured in detail and according to 

fact. To be sure, it was only a Mr. Tasch relating of a Mrs. 

Tasch. 

“The described phenomena of so-called alternating conscious- 
ness also plainly result from the distraction, that is, the inner 
tearing asunder of the personality; and, according to my ex-| 
perience, it is a frequent sign of catatonia. ) 
“Not seldom, pedantry is evident in our cases, such as we 
are accustomed to see in epileptics. The patients are excessively 
punctual, like clockwork, scrupulous, have the apportionment of | 
the day by heart, arrange their doings and carry out the physi-. 
cian’s orders with painful exactitude, according to the stroke of. 
the bell. They work only in the hours prescribed by themselves 
or those about them, note every piece of linen, keep accounts, 
maintain the closest oversight with regard to everything taken in 
or given out and concerning all utensils. Sometimes, too, they 
seek to find a reason for their pedantry and to uphold it as 
natural. Others work with the greatest care and industry, but 
with little productivity in it all. | qi 


+, 
4 


of 


“In some cases, there has been noted a marked inclination to 
collect all kinds of things. 

“Sympathy and antipathy are often present. The patients 
appear very pleasant to certain persons, trusting, obedient; to 
others uncivil, resistant, aggressive. 

“Many catatonics move in extremes; they oppose, at first, 
every order but immediately afterward carry it out of their own 
accord. If what they ask for is given them, they refuse it; com. 
plain afterward that they are restricted and treated like persons 
under guardianship. 

“Extreme vacillation and lightninglike change of mood are 

often remarked. Sudden transition may be observed between 
violent rage and the most friendly clinging to one, between anger 
and amiableness itself. Laughing and weeping, pleading and 

scolding, gentleness and brutality, strive with each other and vary 
with extreme suddenness. Catatonics quickly form the most in- 
timate and tender friendships, which just as promptly turn to the 
bitterest enmity and the deepest hate; great admiration passes 
over into evil contempt. A patient ‘strikes and scratches a nurse 
who is immediately after overwhelmed with tenderness.’ Of 
another we read, ‘Struck the doctor hard with the foot, then fell 
on the knees before him, wanting to kiss his hand.’ 

“Strong suggestibility is present in the sphere of the will. 
Catatonics are subject at every stage of the disease to any influ- 
ence from the outside, to changes of mood through pleasant or 

unpleasant impressions. They show themselves creatures of the 

environment, dependent to a high degree upon their surroundings, 
very accessible to all encouragements given them and to what- 
ever is acting upon them. They laugh with one and weep with 
-another. Change in the environment, threat of intervention, 
friendly address or command, may likewise promptly modify 
their condition, while they cling stubbornly to many ideas and act 
in a completely stereotyped manner. Easily directed on the one 
hand, they bar themselves often in a rude, impulsive way against 
any external influences, betraying thereby an astonishing tenacity 
and a marvelous consistency. 





28 


currences. They have full understanding of what is pathological 
in the disturbance, a clear consciousness of the unreasonableness 
of the compulsive manifestations, but there is no possibility of 
becoming free from them. They feel the strangeness of the situ- 
ation, are sensible of the burden. They are obliged to perform 
one thing or another; they cannot stop this or that; they must do 
soandso. ‘Do you think it tastes good to me?’ said a coprophagice 
patient to the physician, ‘but I have to do it.’ Another expresses 
it, ‘I do not eat my excrements because I enjoy that, but I think 
I have to do it.’ Many patients are driven, as it were, by an inner 
power always to perform the opposite of what they should. The 
impulse to do the very reverse comes so suddenly that it is im- 
possible for them to withstand it. 

“Sometimes we find among the catatonics individuals with 
homosexual tendencies, pederasty, and other perversities of the 
sexual feelings. 

“While the presence of the pure catatonic signs * stamps the 
form of the disease, the absence of such symptoms is no proof 
that this psychosis does not exist in a certain case. When, however, 
pure catatonic signs are absent, the diagnosis is made possible by 
the demonstration of disturbances within the separate elements 
from which the intrapsychic disharmony and contrasts result. 

“We have seen that in the catatonics every psychic sphere i 
represented, we may say, by a special person, who, without con- 
cern for unity, is occupied merely with his own part. From this 
we deduced the difference between subjective feeling and the 
inability to objectify it. Thus has to be explained the disconnec 
tion between content of ideas, emotional reactions, and deeds. In 
such manner we must interpret the gross discrepancy betwee 
external irritation and emotional answer, between the strengt 
of the stimulus and the effect in reference to the severity of th 
pathological symptoms. As further result of the intrapsychic dis- 
harmony we note: the superficiality and inconstancy of the affect 
ive life, the abrupt change in emotional excitement, the excessiv 
alteration in mood. 

“The affect breaks out as violently as it quickly disappears and 
puffs out. It never corresponds in its strength to the agent whic 
has provoked it, and therefore the person concerned responds ait 





{ 
\ 


| 


* We have named them on page 12. 
\ 


| 
“f 





ao 


vivid reactions to external or internal events of little importance. 
The patients may remain entirely insensible toward many severest 
stimuli but react very promptly to others even minimal in degree. 
‘In the same way, they appear to be totally transformed in their 
entire conduct by fancies suddenly occurring to them. 

“Characteristic for these patients is the complete failure of the 
adequate feeling tones. Everything that the catatonic does or says 
in unnaturally exaggerated in a good or a bad sense. His af- 
fective discharge is often immoderate, his resistance or compli- 
ance boundless. Implicit obedience, touching kind-heartedness, 
gratefulness, and friendliness exist on the one hand; obduracy, 
willfulness, and rudeness on the other. His scrupulousness and 
punctiliousness degenerate into pedantry. His diligence is ex- 
aggerated, monotonous, aimless; his mental horizon becomes 
quickly limited. 

“Disturbances of the harmonic connection between the psychic 
functions and the absence of mental balance are responsible also 
for the uneven, abrupt, meaningless, nonadjusted behavior, which 
is reflected in all the catatonic’s speech and writing. High-flown, 
affected, flowery and adorned phrases, together with catch-words, 
are mingled in trains of thought which the patient defends with- 
out any emphasis; a bombastic jingle not infrequently conceals 
the superficial and empty content. 

“The clinical product of the intrapsychic disharmony has been 
duly set forth in the summaries of the cases. No one but the 
catatonic can receive the news of the death of a parent, toward 
whom he feels no hatred, and calmly proceed with the reading of 
the novel he has at the moment in his hands, or give expression to 
a cynical remark (Cases 11, 18, 29). Only a patient of this 
sort will quietly satisfy his appetite immediately after the most 
violent discharge of affect (Case 16, 29, Pat. N., Pat. D.). No 
psychopath, hysteric, or manic-depressive, but the catatonic only, 
in letters excellent in style and construction, unusually subtle in 
content, even poetic in expression, can be guilty of such gross 
errors in orthography and grammar; whereby the same words, even 
in the same line, are written both right and wrong (Cases 4, 12, 
29, 30). , 

_ “Many patients of this kind will give up a long-planned jour- 
ney, for which preparations are already made, because they have 


| 


30 


dawdled away the time in packing their wardrobe, so that they 
think they cannot make the train. Others weep because 
they are sad and likewise shed hot tears if their bath is delayed a 
few minutes. Solely and only in a disturbance of the harmonious” 
balance within the psychic function is it possible that any one who 
‘could and must keep on weeping’ stops doing it and begins to. 
satisfy his appetite, ‘because, otherwise, the chicken would get 
cold.” (Case XXIX). It can be said merely of a catatonic: | 
‘Lies still on the sofa. “Oh, how much good that does me! You 
have no idea what pain I feel in my whole body!*’ Then sud- 
denly springs up, dances and stamps with the feet.’ 





“It has been established so far only in catatonics that they will 
give way to lamentations with a quite cheerful expression of 
countenance, and, on the other hand, weep while reciting happy 
recollections. None but catatonics will part reluctantly from 
those whom otherwise they extremely hate. [Exclusively patients | 
of this sort make bitter complaint to strangers that their nearest 
relatives have no concern for them, take no interest in their fate; 
while at the same time they will repulse in the rudest manner any 
attempt of their parents to approach them. 






“A clergyman who, having become melancholy—as it is called 
—could mutilate himself under the influence of the idea of sin,| 
because he had as a boy wrong habits, such an one is suffering 
from catatonia, even when he does manifest all symptoms which 
would justify the diagnosis ‘melancholy.’ When a farmer’s wife, 
because she has great pain in labor and the birth is delayed, per- 
forms laparotomy upon herself with a knife and takes out the 
living child, then stops up the wound with dirty rags, and begs 
the doctor who visits her later to be careful and not to hurt her; 
the diagnosis of catatonia must be made even if symptoms of 
psychic illness so far have not manifested themselves. Only a 
catatonic—general paresis cannot be seriously considered here— 
would bring forth ideas of this sort.* 





* The patient, who died soon after from septic condition, was described 
in the Moscow Medical Journal as an “obstetrical curiosity.” Noteworthy 
here is the disharmony between the sensitiveness toward labor pains and 
the apparently total lack of sensibility in carrying out hara-kiri. I read 
recently, during my stay in Chicago, of a man who made a dozen attempts 
at suicide within a few days, but each time was rescued at the right 
moment. He finally climbed upon the roof of a high building, ¢rept into. 


| 
Me 


31 


“Countless other diagnostically valuable examples of catatonic 
modes of thinking, freakish ideas, fancies, and mad actions will 
be found in my former works. I may merely refer to them 
here. 

“Catatonia, furthermore, always catises a continuous altera- 
tion of the psychic personality ; psychopathy and hysteria, never. 
It is also true that in psychoses on a degenerative basis defects 
of logic do not exist, and the process as such does not advance. 
Delusional ideas would not be found elaborated. Incoherence in 
the train of thought, lack of judgment, senseless fancies and com- 
binations of ideas, monotony in action exclude—and this is also 
Kraepelin’s standpoint—the diagnosis of psychopathy and hys- 
teria; while shrewdness, deliberation, calculated cunning, desire 
to dominate and premeditated stubborness, peevishness and sen- 
sitiveness, do not speak in favor of psychopathy. It is quite 
inadmissible, however, to deduce the degenerative character of a 
psychosis from clever cunningness in action, skill in defense and 
resourcefulness, or from the caution with which a deed is carried 
out. 

“Tt is often astonishing how refined in their cunning catatonics 
can be; how extraordinarily they control themselves in order 
merely to fulfill their purpose; how much energy they develop 
when it concerns the pursuit of a definite aim; how craftily, boldly, 
and artfully they go about the carrying out of a plan; how they 
hoodwink quite intelligent people and deceive them. One can 
scarcely believe how discreet they are in talking with the physician ; 
how few pathological signs they allow to be seen, in so far as it 
concerns their possible release from the asylum. In long speeches 
they try to persuade the doctor of the necessity of their discharge, 
avoid very wisely all that could be interpreted to their disad- 
vantage, adding such fictitious things as are favorable to them- 
selves and sound quite convincing. Their ingenuity in escaping 
from the institution or the craftiness with which they carry out 
a suicide is often a marvel. If these cases, nevertheless, can be 
correctly diagnosed, it is only on the ground of the intrapsychic 





an iron cask which he found there, started it going, and rolled himself 
into the other world. The man was undoubtedly a catatonic. A catatonic 
must that man be also who, according to American newspapers, with 
suicidal intent drove with a hammer a great number of iron nails into his 
skull. 


32 


disharmony demonstrated as present at this same time. One 
patient, for example, who threatened to hang himself or throw 
himself under a train when he got out of the institution, suc- 
ceeded in escaping. He wandered about for days and came 
back to the sanitarium of his own accord in a good condition. 
Another, who had made very serious attempts at suicide before 
being interned and repeated these in the institutions, showed 
himself very skillful in getting away, but came back of himself 
to the asylum. Some patients, who had laid cunning plans and 
did finally escape, came back spontaneously because they “found 
their friend’s house closed,’ the way home was ‘too far,’ or for 
any other foolish reason. 

“As can be seen from the case histories given here, there are 
patients enough who betray absolutely nothing morbid in letters 
to the physician, or husband or wife, whom they seek to convince 
that they are already quite well and can be taken home; while, 
at the same time, in writing directed to their children, they show 
themselves foolish, even crazy, and never do they draw the ob- 
vious conclusion that the husband or wife will of course have 
knowledge of these letters. On the other hand, it can be plainly 
seen that patients who were in any direction silly, senseless, and. 
confused, when they have made out a legal document, exhibited 
before the notary or judge complete ability to draw up a will. 
They behaved themselves, for a period of time, so correctly that 
the right of disposal would not have been refused them, if their 
former life had not been known, and, as frequently happens, | 
they had not immediately after shown, in a special cross-examina- | 
tion or even spontaneously, a quite feeble-minded conduct. 

“As precursors of the disease, we find aberrations in widely 
different spheres of the emotional life. Signs and traits of char- 
acter can be traced often to the earliest childhood and may he 
understood therefore as catatonic peculiarities. 

“Such peculiarities, which can be regarded as most primitive 
forestages of the fully developed form of the disease, are often 
evident in the ascendants of these patients. Sometimes they re- 
main the whole life through without becoming plainly manifest 
and are interpreted as personal idiosyncracies in the sense of 
hysterical or degenerative constitutions. 

“Very important, however, is the fact that psychoses, by) 


| 
| 








Ss 


33 


direct inheritance, have an unfavorable influence upon later gen- 
erations. This does not in any way mean that the descendant 
must become sick. Direct offspring may remain quite sound, in- 
tervening generations be spared and skipped over. But if a psycho- 
sis develops in the descendants, it takes on from the beginning 
a more menacing character. Whether this is the way in which 
human beings submit to inhibition in propagation of inferior in- 
dividuals, and Mother Nature tries hereby to bring about an early 
destruction of such worthless living material, must remain unde- 
termined. As a rule, we affirm, however, a marked progression 
of mental disturbances in each later generation. This is due not 
merely to the fact that the heredity is perhaps added from both 
sides, for our conception has been verified even there where only 
one of the parents bore the bad heredity. 

“Especially to be noted in such cases is the evident tendency 
to grow worse on the catatonic side; and just in those families 
where the mental disease affected several generations, the pro- 
gressive appearance of catatonic symptoms was unmistakable. 


“Frequently the following types were demonstrated: Among 
the members of the first generation were found extravagant, shy 
individuals, odd, eccentric natures, hysterics and psychopaths, who 
sometimes became ill at an advanced age with a psychosis without 
purely catatonic signs. In the second generation, mental disturb- 
ances could be observed already at a very early period. These 
were psychopathologically or catatonically colored, and not seldom 
they led to deterioration; while the other members of the third 
generation immediately after the first attack showed a character- 
istic defect and had to end their life in the asylum. Frequently, 
the parents suffered from conditions which still lay at the border 
of the normal or from psychotic manifestations with or without 
catatonic symptoms, often in a degree that institutional care was 
scarcely indicated and, on the whole, no deterioration ever ap- 
peared ; while in the children, immediately after an attack, psycho- 
pathic or catatonic in nature, a typical terminal state developed. 

“This progression of symptoms could be established—and this 
urther attests our theory—in families where the descendants be- 
came ill before the ascendants. Here also catatonic terminal 
states were observed in the children, while the psychosis of the 














34 


parents, which broke out much later, perhaps not until the cli- 
macteric, showed a significantly milder course and outcome. 
“The circumstance is worthy of note, furthermore, that often 
in the beginning of the psychosis zdentical clinical symptoms ap- 
peared in parents and children, brothers and sisters, who became 
ill at different times; moreover, that the outbreak of the disease 
and of its return was not only provoked in the same patient by the 
identical cause, for example pregnancy, but that the first attacks 
in parents and children were repeatedly brought about through 
the same cause, perhaps a birth. Many times the psychosis broke 
out in ascendants and descendants at the same age. In our study 
on late catatonias,’+ are described four women who became ill at 
the climacteric and whose mothers years before, because of a 
psychosis also developed in the climacteric period, were interned 
in the same institution. Here again attention should be given 
to the determined fact that the mental disturbances in the parents 


showed a much milder course and better outcome, while in the — 


children the disease was prolific of catatonic symptoms from the 
very beginning and quickly brought about deterioration. 

“Thus is explained the fact, illustrated here by a large num- 
ber of suitable cases, that we meet families in which the parents 
may have passed as psychopathic, while the children themselves are 
catatonically demented. Nevertheless, in my former works 1 
have denied a heterogeneity of forms of the insanity in such cases. 


We have to do with psychoses clinically the same but in certain ~ 
members not yet fully developed and matured. Among other — 


things, it was possible to assert that in the ascendants frequently, 
not only psychopathic symptoms, but also intrapsychic disharmony 
and laceration of the personality can be determined; further, that 
the degenerative signs often only form the starting point of a 


catatonic disease which leads to typical defect. Besides, the psy- : 
chopathic peculiarity is frequently found in the anamnesis of © 


descendants who later become catatonic. Moreover, it is very 
often established that descendants who themselves show no de- 
generative character but are born of persons of psychopathic con: 
stitution develop equally severe catatonic symptoms and finally 
deteriorate rapidly. 


“Of course, it must be admitted that the characteristics about © 


to be portrayed here appear also as such in the degenerative psy- 


\ 


35 


choses, only it is not correct to affirm them more frequently for 
psychopathic states. Because catatonia may during years or de. 
cades—and this today is so rarely taken into account—be pre- 
paring itself through psychic anomalies, which not only resemble 
those of the degenerative conditions but are fully equal to them. 

“In any case, harshness of disposition, rudeness, lack of sensi- 
bility toward moral and ethical influences, appear so often in cata- 
tonics that we may well speak here of a nuclear character. Such 
individuals have shown themselves thievish all their lives, some- 
times have had an actual impulse to steal, or were malevolent, 
gruff, contrary, without scruple or conscience, morally depraved, 
not at all amenable to discipline, and often had to be placed in 
penal institutions. Certain ones were fond of torturing animals; 
others, it is true, loved animals above everything else and lived 


with them as with their own kind. Not infrequently, inability to 


ee 


enter into the emotional state of another shows itself even more 
in youth, together with lack of consideration, pity, and sympathy. 
Different patients are pictured as if being always rough, intriguers, 
defiant, irascible, perverse, resistant. They fly into a temper over 
little things, make violent scenes about nothing, show themselves 
resentful, sullen. They did not speak for days, perhaps on ac- 
count of some insignificant dispute. They have run away from 
home after a light admonition from the parents; have withdrawn, 
shut themselves in, purposely done just the opposite to what 
they should. 

“Others are irresolute, change with the weather, cannot be 
depended upon, are given to sudden transitions, subject to caprice, 
inconsistent ; they have neither goal nor plan. They are braggarts, 
bullies, show a man‘a for exaggeration, sometimes in very pleas- 
ing phantasy. Still others are easily misled, find no difficulty in 
being submissive to some one else, are readily persuaded, willing 
to acknowledge authority. Or they appear as champions of all 
sorts of reforms, defenders of special views; they become most 
eager disciples of totally ridiculous methods of healing or they 


preach new doctrines. 


Others appear as prophets, ascetics, devotees of nature, world 
reformers. They go into criminal circles to convert the people, 
but are themselves sometimes led into paths of evil. They give 
away all they have, enter into marriages outside their own circle 


36 


in order to ‘overthrow privilege and class distinction.’ They want 
to uplift fallen girls, marry prostitutes ‘to lead them out of the 
path of destruction.’ 

“But even as the psychopath by no means manifests only bad 
and negative traits of character, so in the catatonic, too, there 
may appear warmth and fineness of feeling, tenderheartedness, 
indeed, the highest social and altruistic impulses. Sometimes, to 
be sure, this consists in ideal phrases, sentimentality, a conscien- : 
tiousness which amounts to self-torture. Often, however, there | 
are natures of deep susceptibility, devoted to duty, self-sacrificing, | 
tender-hearted, easily moved to tears, sensitive to blame. 

“In the intellectual sense, there are found in these very forms | 
of catatonia in different fields remarkable characteristics, circum- | 
scribed abilities, marked talent, distinguished intellect, precocious 
mental development, ready conceptual power and unusual discern- | 
ment, logical thinking and philosophical tendency, lively ambition | 
and an urge toward knowledge, aptitude and ability in a pro- 
fession, linguistic, literary, or poetic qualification, striking memory | 
for numbers. Also a highly developed aesthetic sense, apprecia-_ 
tion of art, talent for music, painting, or handwork were noted 7 
in the anemneses. Often these patients were the most wide- 
awake, excelled in their work, were indeed master students who 
took great pleasure in learning, which came very easily to them. - 
We read, for example, of one patient: ‘Distinguished himself by 
great mental capacity and remarkable diligence. Later, also, as” 
a merchant, untiring, active, faithful to duty, and works assidu-_ 
ously to develop himself in every direction.’ Another ‘sought 
with all his power to enrich his knowledge and had scarcely a 
thought except for his books.’ A third ‘has achieved distinction 
in mathematics. * A catatonic, who rapidly became totally de-_ 
mented, ‘at thirteen years of age gave her opinion upon the most | 
serious questions like a mature individual. She was one of the 
noblest and greatest souls and strove always in self-sacrifice and 
love for her kind; she worked and accomplished much. We 
read of one patient, ‘Her opinions early were sound, practical, and. 
of a remarkable philosophical profundity’ Another was ‘a rare, 


4 


harmonious, always cheerful nature, at all times affectionate and 





* The words emphasized here and in other places are given thus in the 
original text. 


oF 


compliant, but gradually became forgetful, incapable of thinking.’ 
One certificate reads: “Very talented; passed a brilliant examina- 
tion. According to his knowledge could have appeared much 
more sure of himself ; he comes too little out of himself.’ Another 
deteriorated patient ‘was always such a good child, friendly and 
well-disposed toward every one, especially toward the poor and 
needy; in the highest degree natural and open—altogether so en- 
tirely different from what she became through her illness.’ Of 
one patient it is reported: ‘As a child quiet, wide-awake, later 
lively, quick in comprehension. Showed great talent for music, 
fond of poetry, well acquainted with literature. Truth-loving, 
earnest, good-hearted.’ 


“In our Case II, the deteriorated patient ‘was well-endowed, 
unusually alert. She later showed a talent for music, was imagi- 
native, possessed aesthetic taste and harmony, had a keen eye for 
form and order. She was domestic, very practical and energetic 
in a certain sense. She had her own will; was self-conscious, 
but loving and dutiful toward her own family, a true friend; 
somewhat superstitious.’ Once we read: ‘A very active child 
In school comprehended and learned readily. Wrote good essays, 
but always different from what was prescribed. Showed sound, 
clear judgment. Also, when no one was present, she preferred 
to indulge ina rich phantasy. Evenasa child, the thoughts would 
fly away. Patient imagined stories in which she played the chief 


role. For years, she went with her parents into society without 


anything essential being noticed. She entertained herself very 
nicely with pleasant fancies. At twenty-eight years of age she 
withdrew: “I can’t do it any longer.” She became more and 
more shy and retiring. She was brought to the asylum, where 
relatively quickly a catatonic end state established itself.’ Another 
patient (Case III), who has lived in the sanitarium for forty 
years, ‘as a child was lively, with a talent for poetry. The in- 
clination to occupy herself with writing in poetic form appeared 
more and more prominently—and could not be suppressed. This 
talent and a beautiful soprano voice were united with a self- 
denying and lovable nature, which drew many friends to her. A 
work of the patient written after a journey to Switzerland testi- 


fied indeed to a highly gifted and very sensitive nature. She had 


38 


produced a large number of excellent poems, many also of a 
humorous sort.’ * 

“It has been shown already in our former studies that many 
patients are able to accomplish things worthy of consideration not 
only up to the outbreak of the psychosis, but also during the 
free intervals. This could be ascertained especially in those cases 


of catatonia which run a psychopathic course. Certain finally | 


deteriorated patients, when recovered from their first attack, 


continued to study with ardor and finished with honor at the © 


university or academy. Others showed much skill in technical 


ability and won prizes and recognition for scientific or artistic — 


achievement. 

“Many, after dismissal, set up their own establishment, de. 
veloped their business in a field perhaps newly chosen, showed 
themselves clever in accomplishment and completely satisfied 


all requirements. Such abilities, of course, do not in themselves | 


exclude even striking psychic defects, for it is often seen that 


patients in the acute catatonic stage in many situations perform — 


astonishing tasks, still acquire new intellectual experiences and 
possess the impulse to think about and to learn new things. But 
our above-mentioned patients, in the time between attacks, have 
manifested nothing that would be designated as morbid. We know 
it from the fact that many of them were in constant relation 
with psychiatrists, who, when the patients were readmitted, at- 
tested the absence of apparent pathological symptoms until the 
fresh onset of the disease. Besides, in people of higher position, 
who have many social duties, every deviation from the normal, 
even if it is not interpreted as a residuum of the illness passed 
through, must manifest itself still more, and, in fact, was not 
overlooked by the relatives. This became evident from the 
anamnesis, in which the patients’ peculiarities were pictured as 
something that had not been present before the attack. 

“Our records show also that patients with grave defects—as 
well as in acute catatonic stages—make visits or take, with at- 


tendants or nurses, long pleasure trips. They occasion no re- 


marks at concerts or the theater, where they follow the program 
and can tell about it afterward; further, they readily look after 





* Of other characterizations of catatonic patients we will speak later, 
page 102 and following. 


39 


their nourishment and take care of their bodies, always buying 
in the most expensive shops the best and finest things, showing 
a good deal of initiative. 

“Others may carry on their business or manage their own 
affairs; they also control the accounts of the institution in which 
they are; often they show such good judgment in everything 
that does not concern their ego that independent rights cannot 
legally be taken from them. 

“Tt should not pass unnoticed that very little weight is laid 
in our case histories upon intelligence tests—quite rightly, we 
think.* School knowledge is also forgotten by the mentally sound. 
When a lady of good birth, however, becomes untidy in her dress, 
uncouth in society; when she is ill-mannered at table, lets her 
nose drop while a handkerchief lies near; or when a man with an 
academic education, who has moved in the best society, shows 
himself quite primitive among his acquaintances, as well as in 
eating, uses the hand instead of the fork, the napkin for his hand- 
kerchief: so does this point to dementia in the catatonic sense, 
even though the intellect has not suffered in the least. 


“In the same manner, pure memory performances also have 
no value. This is evident, for instance, from our Case XX: 
Scarcely expecting a right answer I questioned the highly de- 
teriorated patient whom I visited in another sanitarium eleven 
years later; Dr. L. in his time asked you something that you 
should keep in mind; do you still know what it was? ‘Yes, I 
know; he always asked me about the migration of the peoples 
and the treaty of Verdun.’ You are right. Can you tell me 
when that took place? ‘In 843’ (correct) 7 


“Another patient (Case XV), interned in the asylum since 
1873, was asked: Do you know the number I mentioned the last 
time over a year ago. ‘Yes, I still know it’—smiling—I am very 
faithful and conscientious about such things. I kept it in mind, 
8764. So naturally—naively, like a child, I explained to myself 
—demonstrates this on her fingers—‘8 less 1, 7; less 1, 6; and 
half of 8, 4; so 8764.’ 





* Compare pages 72-73 and 120. 

+It is important to note that in her acute state the patient has 
failed in reproducing these events. Already after some hours, she gave 
totally wrong numbers. Probably this was due to negativistic tendencies. 


AO 


“Intelligence tests in general have but little value also for 
another reason. Apart from the fact that it is often very diffi- 
cult to get the patient’s attention or to have his consent to an 
examination, it cannot always be determined how much defect 
is to be attributed to temporary disturbance of consciousness and 
attention, or to loss of interest, displeasure, and negativism.t Be- 
sides, intelligence tests ought, very often, to be repeated. We 
have described catatonics who are quite senseless for months and 
years, until a cake or chocolate has given them occasion to im- 
press others with their knowledge. It is well-known, further, 
that the purely intellectual sphere suffers less, and, at any rate, it 
fails last. 

“According to my experience, little importance, from the dif~ 
ferential-diagnostic viewpoint, is to be given to psychological in= 
vestigation, especially associations. Of highest value are the signs. 
of intrapsychic disharmony; as even the affective disturbance, 
which constitutes a basic feature of the disease, may be less pro- 
nounced for a longer time. In some cases it is possible to set 
in motion feeling impulses through stronger, more complex stimuli, 
when weaker, simpler ones fail. Thus, for example, a patient, 
being told of the death of his parent, remained quite indifferent, 
but seeing his sister weeping and in mourning, he himself had 
tears in his eyes. | 

“In the far greater number of cases, however, the anamnesis 
testifies that catatonics are moderately or poorly endowed, shy, ex~ 
citable, quarrelsome and unbearable. 

“By far the most frequently, the psychopathic forms of cata-. 
tonia develop stealthily, subacute. They may break out at any 
period of life; but they are more often observed in intellectual 
private patients than in community ones, in whom the catatonic | 
states predominate from the very first. It must still be determined 
whether or not that is connected with the higher organization 
of the brain in the former class. 

“For the most part, indeed, the deterioration goes on progres-_ 
sively until the entire mental personality is rent asunder. We 










~ Compare the footnote page 39. 

§ The outcome of the psychosis quite essentially depends upon the 
cultural level of the person afflicted. It is shown in my records of 1912 
that, from 1,900 individuals of high intellectual grade and 1,700 community 


41 


have seen, however, that the disease is less to be attributed to a 
destruction of the different spheres as such and rests rather upon 
the intrapsychic disharmony, contrasts, or derailment within the 
individual functions; so that the threads of the psychic life are 
separated but not destroyed. For this reason, occasionally, ap- 
parently even in advanced deterioration, unexpected knowledge 
and ability make their way out of the heap of ruins, and functions 
may be performed which for years have been considered lost. 

“As premonitory manifestations of catatonia may exist for a 
long time symptoms interpreted as nervousness, hyponchondria, 
hysteria, or psychopathy. At other times, there appear feelings of 
insufficiency and other melancholic features, or excessive haste, 
activity and enterprise. Most frequently, it is true, the loss of 
intrapyschic harmony, as well as the doubling of the personality, 
both diagnostically so important signs, make themselves known 
even in the beginning of the disease. 

“On the other hand, as has been mentioned in my earlier 

works, a morbid disposition plays its part in catatonia. The 
psychic disturbances which later break out openly are thus fore- 
shadowed in the constitution,’® because the germ cells from the 
very first are defectively disposed, and the organs fail in their 
intrasecretory production. The psychosis slumbers, one might 
say, and only awaits a summons, which draws it from its latency 
to the light of day. 
_ “That the catatonic disposition can be awakened to life through 
‘the most varied causes is proved by the outbreak of the mental 
disease after all sorts of infections and intoxications; in connec- 
tion with adolescence and processes which stand in relation to the 
generative functions; further, as a result of accidents, especially 
injuries to the head or psychic shocks. In many patients, cata- 
tonia sets in under the stimulus of affectively exciting external 
factors, 

“The circumstance that certain symptoms and phases pre- 
sented themselves again and again made it possible to separate 
out the psychopathic varieties of the catatonic disease and to 
predict their further development. Despite the different life 


patients who were investigated thoroughly for this purpose, grave defects 


had developed eight times more rarely in the cultured catatonics than in 
the average patients. 





as 


42 ‘ 


epochs in which the illness may break forth and regardless of the 
manifold features observed in the beginning of the psychosis, the 
unavoidable end of the disease is, up till now, always the same; 
namely, destruction of the whole personality and a somewhat 
special form of deterioration which results from it. Since, how= 
ever, the fundamental elements always agree, from the start the 
cases must, without hesitation, be included within the borders of 
catatonia.” ‘ 


At the close of this symptomatological portion of the work, we 
will now make an excursion into the territory of neurology, in 
order to show that in this science—which lies somewhat close to 
psychiatry—we likewise perceive anomalies that, however puzzling 
to the uninitiated, are demonstrated easily by the specialist ag 
result of organically conditioned severance, interruption, or deg 
struction of the associative paths of the brain. 

There are morbid conditions known as “word-deafness” ane 
“word-blindness.” Persons thus afflicted are unable to compre 
hend speech, but they speak themselves well and freely; they 
cannot repeat words, cannot write from dictation, but are able 
to write spontaneously. ; 

Others speak well and may be able to read aloud, but they 
do not comprehend written or printed words. They may be un- 
able to write spontaneously, but they should be able to do transfer 
copying. Sometimes they are able to write from dictation and 
spontaneously, can do transfer copying, but they cannot read their 
own writing. We know patients who speak fluently, read _ 
well, and understand what they read; but they are not able to 
write from dictation or spontaneously; though they can do transfer 
copying. Often a patient understands all that is said and coms 
prehends what he reads; he speaks spontaneously and repea $ 
words when bidden; but he is unable to read aloud, to name at 
sight, to write from dictation or spontaneously, though ability 
to copy writing may be preserved. i 

In cases of “mind-blindness” the patients see all objects; but 
they cannot name them, nor do they know how to use them. © 








43 


Sometimes a person cannot speak, for instance, the word mind. 
If the patient is given, however, the four single letters one after 
another, he is able to make the syllable mind. It happens also 
that a person is unable to repeat from the alphabet some few dis- 
tinct letters. 

There are patients who write spontaneously or from dictation, 
but they cannot copy. Others have lost the ability to write spon- 
taneously or from dictation, though they can copy. 

Bastian *° has seen a lady who did not hear the ticking of a 
watch on either side even with contact. She heard, however, a 
tuning fork although some inches away from each ear. 


Abecrombie ** referred to a gentleman who could not be made 
to understand the name of an object if it was spoken to him, but 
understood it perfectly when it was written. His mental faculties 
were so intact that he was engaged in most extensive agricultural 
concerns, and he managed them with perfect correctness. 
Charcot ** referred to a case of a player on the trombone who had 
lost the ability to perform movements of the mouth and of the 
hand necessary for playing on the instrument. All other move- 
ments were unaffected save this one. 


Trousseau ** described a patient who, “when shown a night- 
cap and asked to name it, after looking at it attentively, could not 
say what it was called and exclaimed, ‘And yet I know well what 
it is, but I cannot recollect.’ When told that it was a nightcap, he 
replied, ‘Oh, yes, it is a nightcap.’ The same scene was repeated 
when various other objects were shown to him. Some things, 
however, he named well. He was a navvy and therefore worked 
chiefly with the shovel and the pickax; but he could never tell us 
what tools he worked with, and when I told him he would reply, 
‘Oh, yes, it is a shovel and pickax, and two minutes afterwards 
he was as incapable of naming them as before.” 


There are cases ** with preservation of an ability to sing or 
whistle airs correctly, with the aid of a few sounds or syllables, on 
the part of patients who are speechless. 


Falret *® noticed a class of cases concerning patients who were 
able to sing airs; could also sing the actual words of a song, al- 
though they could not, either before or afterwards, pronounce the 
words alone voluntarily. 


44 


Gowers °? also described a patient who could sing songs cor- 


rectly with the actual words, though his spontaneous speech had 
been abolished. 


Grasset ** mentioned “an officer who could only utter ‘pardi” 


and ‘b’ and was quite unable to pronounce the words ‘enfant’ and 
‘patrie’! Nevertheless, he could sing correctly, both as to words 
and music, the first verse of the Marseillaise.’ 

Bastian ** has published a case of “almost complete loss of 
voluntary speech, together with a marked ability to sing not only 
airs but the actual words of hymns and ballads with wonderful 
fluency and correctness.” 

Many cases are on record in which there has been a blindness 
but only for notes. Charcot ** referred to a patient who could 
not decipher a single note, though he could play correctly. A 
patient of Finkelburg,®* again, could play from memory and play 
the airs which he had heard sung or played by another, though 


he was quite note-blind. Proust ®® refers to a patient who could 


compose and write musical notes, though he was quite unable to 
read them. 

Very often occur cases of tone-deafness, which can also be an 
inherent defect.°° Such patients hear everything except music, 


and they remain quite incapable of distinguishing one tune from. 


another. Willie,°® who gives good instances of this, also points 
out that “the development of a musical ear seems to bear no in- 
timate relationship to the development of the other faculties of the 
mind. It is shown that many men of genius have been utterly 
destitute of a musical ear; and it is further known that in idiots 
and imbeciles, the musical faculty is often well developed.” 
Lichtheim °” described a patient “who had formerly been mu- 


sical, but he lost the power of recognizing even common melodies 


and sometimes asked his children to stop singing quartettes ‘as they 
made too much noise.’ ” 


Edgreen *8 has seen “intelligent and musical men who were 


unable to make out the melodies played. They could only hear 
indistinct sounds and could not even distinguish between a march 
and a valse or a polka.” 


| 


—— fe 


45 


‘Experience teaches that catatonia begins from a definite point* hal 


on with a transformation of the whole personality, while the af- 
fected individual often becomes the advocate of a special system 
of thought or doctrine and a passionate champion of reform. At 
bottom, such ideas are anything but “reformatory,” because even 
the most intelligent patient in that moment no longer avails him. 
self of the psychic force, the energy, and the consciousness of his 
goal necessary to clothe his ideas in suitable garb, such ideas in 
themselves being the product of a sick brain. They naturally pos- 
sess no enduring vitality; they can exist only so long as the en. 
deavor to make them actual does not surpass the limits which 
society has prescribed, and the life circumstances of the person 
concerned permit him to conceal the peculiarities of his thoughts 
and deeds. In the opposite case, there arise conflicts with the 
environment, which, in turn, bring it to pass that the abnormalities, 
the eccentricity, and morbid symptoms come more and more clearly 
to the light of day. 


“We see, therefore, that in the course of the catatonia an in- 


dividual at first still more or less defective falls a victim to total 
destruction, to an alteration that leads to ruin. The healthy ego 
disappears, and, as a result of the morbid process, a totally dif- 
ferent personality arises in its place. 


“The characteristic manifestations of this disease are: weak- 


ness of the will power, deadness to all higher feelings and moral. 
principles, a more and more evident diminution of the mental 
equilibrium, and loss of the psychic personality. To these are 
added a gradual drying up of the consciously directed inner life, 
an indifference toward the future, a narrowing of the circle of 
psychic interests, a disappearance of effort and of the unfolding of 
energy toward a goal—in brief, a spiritual and emotional emptiness 
becomes gradually plainly manifest. 


“Thus catatonia changes the whole personality of the indi- 


vidual affected. More and more his life loses its force and in- 
tensity, so that his thinking process remains dependent in a totally 
unlimited manner upon his morbid foundations. Even when the 
conduct of the patient is quite moderate, when he reveals himself 
still in full possession of his knowledge and makes use of his 





* The following is taken from paper.” 


46 


memory, when purely catatonic symptoms are absent or only © 
present in abortive form; even then, such a person is unable to lead © 


the life which has consciously prescribed goals as its basis and is 


established upon normal assumptions. The judgment of these © 


people is blind or influenced by pathological affects. They are 
incapable of considering results and of foreseeing them; they 
comprehend neither rights nor duties; they are not able to direct 


their actions, they cannot use their reason; they have no clear — 


idea of what is good and what is bad. Just as little is moral 
sensibility a conscious motive of their deeds. Even when they 
are entirely asocial or directed against the community, they con- 
sider their actions as completely in accord with the character of 
a cultural individual. 

“Furthermore, such a person possesses neither ethical sense 
nor the capacity for appreciating moral principles upon which 


mutual social relationships and conditions are established. There © 
is one guide and only one for him—his “ego.” It is not possible 


to make this clear to him, to convince him of the morbidness of 
a given idea, or to bring him to a recognition of the simplest logi- 


cal conclusions. He has his own logic and this he holds as the © 


correct one. He considers as an ignorant person, or even as his 
enemy, anybody who does not share his logic. 
“Besides, an individual who is a victim of catatonia is quite 


unable to grasp the nature of a moral demand, to make it his own, © 
to feel in any way more deeply. Everything with him is shallow, 


superficial. 

“We must, however, learn to know in detail the whole course 
of an individual’s life and not merely certain stages of it, if we 
will form a fair and correct judgment concerning him. For this 
reason, the observation or description which some one has made 
in a given period of time and in the course of separate conversa- 


tions is not enough and never entitles even a physician to deduce © 
a final opinion. This is also the very ground from which so — 


frequently arise the quite mistaken opinions of the public in regard 


to the psychic states of their fellow men; when they see that in a 
given case, according to their position, those concerned acted and © 


spoke reasonably, defended themselves cleverly, without manifest- 
ing thereby anything openly morbid. For all these features with- 
out any doubt may be present at a given moment. Yet this does 


47 


not in the least prove that such factors are sufficient for the lead- 
ing of a righteous life, and that a person who is in possession of 
these qualities is not insane and ought to be considered norma! 
psychically or responsible for his actions. 


~ 


ras 


_ If we give now some details of the deed and picture the man- 
ner in which Leopold and Loeb presented themselves during the 
preliminary investigation, as well as throughout the main proceed- 
ings, we shall find enough defects that we have learned to know as 
catatonic peculiarities. We can, however, refrain from unrolling 
the entire succession of events, the details of which have engraved 
themselves deep in our souls; inasmuch as they were painted 
in colors that cannot be obliterated from the memory for a very 
long time. Nevertheless, certain points may not escape discussion. 

When we consider the case without a preformed judgment, but 
critically and quite objectively, mastering any emotions, we dis~- 
cover facts that make it possible for every intelligent, normally 
thinking man to establish in these boys the doubling of their 
psyche and even the total destruction of their sound personality. 
This we must deduce especially from the motives of the deed 
and the manner in which it was carried out, from the kind of de- 
lineation which the situation has received during the confession, 
as well as from the behavior of the actors throughout. 


The plans were being hatched for some time. Neither of the _ 


perpetrators will at first confess himself as the originator ; “each 


STEREOS A As 


one pushes pushes the euilt upon the other. Despite this, a full confes- 


A i 


sion is given, and the. details described with a totally indifferent 
‘frankness. Not a trace of remorse is perceivable, no word that 
would permit a gleam of inward excitement. Cool, as if it were 
a quite innocent affair, they depict how they took a young life. 
Here also, at first, neither of them will admit that he is the ex- 
ecutor; each one denies the performance of the deed, both wish 
to be only participators in it. 

Directly after its execution, they went to a restaurant to in- 
dulge in sandwiches and sweet drinks, while in front of the 


48 


| building stood the automobile in which the body of the dead boy 


lay. During this part of the confession arose further mutual 
accusations: the earlier close friendship threatened to pass over 


into bitter enmity. Both boys surpassed themselves, however, in — 


their eagerness to give material which could be used against them= ~ 


- selves and were always bringing to light fresh corpora delicti. 


But what motives drove Leopold and Loeb to the performance 
of the deed? Lust murder was not a factor; just as little was it 


an act of revenge! In ordinary lawbreakers or psychopaths with 


criminal tendencies the prospect of ransom money would be the 
third motive for the committing of such an action. But, though 
this moment is actually mentioned in our case, nobody would be- 
lieve that it could be, under normal conditions, one of the impulses 
or in any way a determinant for the carrying out of the deed. 
Even if the youths would insist that they did want to obtain money, 


the allurement of this motive for the justification of such an act © 


in children of multi-millionaires must point to lack of judgment, if 


not to very serious psychic defects. The normal or psychopathic — 
criminal is careful to run no unnecessary risks or to put no spon- — 


taneous hindrances in his way, but to follow the direction where — 


he will find the least resistance. What average thief, for example, 


will use a stick of dynamite to open a wooden box? If the ma- — 
terial side came into the question and Leopold or Loeb had counted © 
upon a sum of money, they could—were they not catatonics—have ~ 


obtained this in many simpler ways. It would not have been diffi- 
cult, for instance, to forge the father’s or uncle’s name to a check, 
to sell one of the parents’ automobiles, to purloin jewels or other 


valuables from the house. They might have hoped that the fami- — 
lies, in consideration of their social position, would hush up the ~ 


matter and not deliver their “misguided sons” to public disgrace. 
Hs Pp g 


Therefore, what was their true motive? In vain should we seek to 


find the ground for their action, if the two boys had not them- 


selves revealed it. 


For Loeb it was: “The pleasure of planning it and the notoriety 


which the - papers would give to the crime and the fact that / would 


“talk it over with other people and derive a thrill from my feeling 
of superiority, in that I knew the true facts about the crime. 
~What is pleasant to me I have a right to do, because I am the , 


99 


greatest individual in society 


———————exe ll le 


49 


And, for Leopold, “It was merely an experiment: such a death 
can be justified as easily as the impaling of a butterfly.” Argu- 
“ments of this sort havé riot yet foiind place in criminalistic-psychi- 
atric literature. Only one case is known to me which permits a 
certain analogy with ours. This concerned a quite uneducated 
young man, who killed a negro by cutting open his body and gave 
as his reason therefor that he wanted to convince himself whether 
“the black man had black blood, or red like the rest of us.” It 
this blockhead, with his thirst for knowledge, thought to advance 
comparative blood findings, so the superman me ani wanted to 
investigate higher problems. He calls himself an “experimenter 
of human emotions.” He wanted to answer the question how it 
would affect a person, if he cold-bloodedly took another’s life. 
He was curious to find out how anybody would feel to recall on 
waking that he had slain some one. 


Leopold believes that people of unusual intelligence and good 
education stand above ordinary human laws and may without 
punishment carry out t acts for which simple men would have to 
“pay a penalty. It is all right when an individual of higher men- 
tality commits a delict for the sake of an investigation of feelings. 


“6 


Another time Leopold said: “In my code, murder is.no crime. 
My only crime was in getting: found out i . . What is pleas- 
ant to me I have a right to do, because: I am an individual. T 


“Fried to cut out the emotional. My idea was cold- -blooded intel- 
lect.” At one occasion he said to the doctor: “I am the great 
“Nathan; when I open my mouth, let no dog bark.” 

Leopold in his present state of disease is, however, nothing 
but a theorist. For me, it is convincing that he did not perform the 
deed. So far as I can judge the material furnished by witnesses 
and reports, Leopold has already lost so much of his initiative and 
spentaneous power for action that he would neither devise nor 
execute such a delict; though he can still accomplish more or less 
adequately anything that rests upon intellectual force. He may 
be also ready to join in with one thing or another in order not to 
be a “spoil sport.” Furthermore, there is no ground for not be- 

-lieving that “it is unpleasant for him to see people suffering 
physical pain. He was fond of small children and had always 
wanted to take a crying child in his arms and comfort it, and in 
such cases he was almost moved to tears.” The same Leopold, 


50 
however, responded at this very time that he is not in the least 
sorry for the killed boy nor for the boy’s family. | 

Absence of inner connection and logical association in the 
thinking process becomes clear from the following *Leopold ans 
nounced yesterday that he would rather be considered mentally — 
sound and be responsible for the deed than to be declared insane, ~ 
He would combat the idea energetically that he is mentally sick I 
and not obey the commands of his counsel, but speak just as he t 
pleased. The following day, however, Leopold maintained a pro. © 
found silence even when not the least harm could have been done ; 
by answering the question. “If it was not you who mutilated the © 
chauffeur R., why do you not say so?” Leopold replied, “Ac- ~ 
cording to the instructions of my attorney, I must respectfully © 
refuse to answer.’ *This could be understood in any case, since 
catatonics in general are uncommonly easily controlled and very — 
suggestible. When Leopold, however, to the question put im- 
mediately after the one above, Would you like a glass of water? © 
automatically repeats, “According to the instructions of my at- ~ 
torney, I must respectfully refuse to answer,’ so is this a somer~= 
sault in logic which we often see in catatonics. 

In his brain, however, this totally contradictory hero of phrases ~ 
always delights in having some new feeling play upon him. 
Leopold explains that he wants to learn to know an emotion ~ 
hitherto unfamiliar to him, namely, how it feels to go to the © 
scaffold. If that is to be his lot, he will die bravely, without mani- | 
festing a trace of fear. Yet he would rather commit suicide at the © 
first opportunity: but he prefers a bullet from a revolver rather ~ 
than poison. He speaks openly and clearly of death; he is not 
afraid of it, nor does he tremble at the thought of it. Besides, 
he wants-to be hanged rather than to languish in prison all his 
life. Some days later Leopold asserts—with his accustomed 
bravado, as the reports say—“If I am hanged, I shall walk to 
the gallows with a firm step * and a smile on my lips.” Then he 
added that it was not conceivable that he would ever attempt to 
commit suicide—now—although testimony was introduced at the 
trial the day before concerning a pellet of poison he had prepared 
earlier for that purpose. ‘‘No jailers need take any precautions 











A *But the same Leopold “almost fainted when I was about to draw 
‘blood from his ear,” the doctor said. 


al 


Sl 


with me; I'll hang, and that’s all there is to it. This suicide talk 
is all bunk.” And when Leopold is questioned as to whether he 
has contemplated suicide as a way to get out of his present dif- 
ficulty, he states that he will not commit suicide, first, because of 
his duty to his family—that he must do as they say—and, secondly, 
-because the trial will be intensely interesting and he will learn 
a good deal and enjoy it. 

Leopold, however, wants to be not only a philosopher but also 
an analyst, a critic. He will not let himself be led to the gallows 
blindfolded. He will go there alone, counting the steps along the 
way and attempting to orient himself. That he loses his direc- 
tion every moment and cannot help stumbling makes no difference. 
In any case, he himself will go to the scaffold with a quiet spirit, 
and, when he mounts it, he will, as if in a ballroom, throw kisses 
with the words, “Pardon, adieu!” Even the laughing which he 
has manifested during the entire proceedings in moments sad 
enough, that “cynical, brutal laughing” over which the press and 
the public have been so incensed, shall not be absent. So says 
Leopold—and I believe that at the moment he thinks so. It is in 
keeping with his personality, his character, and his negative af- 
fect. And not because he could consider the execution a sort 
of glorification, which would accord with his boastfulness, but 
because such people think differently and may often see in the 
scaffold a close to their life which, in their opinion, throws a 
halo about it. Very significant seems to me an allegorical fancy 
created by our patient. “One of the drawings found in Leopold’s 
notebook was that of a bell hanging from a gallows or crossbar 
of a post, and on the bell is written, ‘Nathan Leopold’s Shrine,’ 
the word ‘Eternity,’ and below is the word ‘Maternity.’ 

Besides, the same Leopold, who cares nothing for any one, 
the same Leopold, to whom it seems to make no difference that 
his delicts are publicly discussed, is most deeply offended when, in 
closed proceedings, something is revealed concerning his sexual 
life. “I wouid rather hang than that people hear these undignified 
things about me. What’s a measly thing like hanging? What’s 
death, for that matter? Don’t you like to sleep? That’s all 
death is . . . Hanging would be easier. As Richard says, 
the only regret we'll have, if they hang us, is that we won't be 
able to rezd the newspaper accounts of the hanging the day after.” 


ory 

ag 4? 

4 oa FP ’ 

en =e i} oY 
ca 8 nine 


92 


Catatonics are, so to say, exceptional people. The demands of 
the common laws of life and logic ought not to be made of them. — 


They are like individuals of another planet, endowed with quite 
different powers of thinking and feeling. On the one side, abso- 
lutely emotionless, in other directions morbidly sens sensitive, they 


- Took upon the world around them with other eyes and understand 
it in their own way. ‘To no purpose shall we attempt to prove 


to them how illogical are their conclusions, in vain we would © 


point out to them their wrong assumptions. To them these are no 
errors, for they think as well as they can and attain results in 
accordance with their conceptions. 

On this ground, it is difficult to convince such people that they 
are mentally sick; and for this reason catatonics, in so far as they 
have not gone to complete ruin, try to appear before the court as 
sane, making themselves responsible for their actions. Leopold, 


too, “does not suppose” that he is insane. And at another occa~ © 


sion he said: “As for me, I think this medical ‘psychiatric’ stuff is 
all bunk. I suppose the function of all this is to prolong my life 
as something worth while. I can’t quite correlate this with my 
philosophy, but it is usually considered a worth-while life. Of 
course, | am trying desperately to co-operate with them. 

I do not feel sorry for myself for what I did. I did it, and that’s S 
all. I got myself into this jam, and it’s up to myself to get out. 
I have great feeling for my father and brothers. But myself— 
no. Life is what we make it, and I appear to have made mine 
what it is today. That’s my lookout and nobody’s else. : 
Since my arrest, I have suggested to my folks that they disin- 
herit me, and have nothing to do with me. I feel this might 
bring less ill will from the community upon my family.” But, at 
the same time, “Leopold denied the slightest feeling of grief for 
any harm or suffering he might have inflicted upon others.” 

Our patient Loeb also considers himself mentally sound and 
has no fear of death: “I am not afraid of death, but I don’t care 
to discuss my hanging—yet. No, I’ll never commit suicide. Any 
talk of suicide is ridiculous.” 

An occurrence which took place in a restaurant shortly after 
the confession ought to be understood only in the sense of a 
catatonia. It makes evident in truly classic manner the lacera- 
tion and multiplication of the personality. “There was that Sun- 





‘ 
te 


‘ 


Sg N a 





53 


day night supper over at Weiss’s restaurant, the day the boys’ 
confessions had been made public. A couple, sitting at an adjacent 
table, noticed the well-groomed, confidently poised young man 
who sat there with the two detectives. ‘Why, that’s Nathan 
Leopold,’ the woman murmured, not too sotto voce, to the man. 
And Nathan, the officer told, arose, turned to the woman and 
said, “I beg your pardon, Madame; I am not Mr. Leopold. I 
have been taken for him a number of times.’’* 


This fact—and there are more analogies, too—could put us 
on the right diagnostic track. Then we would perhaps affirm also 
in the physical condition symptoms which are usually regarded 
as catatonic in nature. Sometimes “bare slight choreiform move- 
ments of the facial muscles” even “more when emotions are 
aroused,” can signify grimaces, which belong clinically to the most 
important symptoms of catatonia. 


It is to be emphasized further that the same university pro- 
fessor who, on the ground of the conversation which Leopold had 
with him shortly before the arrest, testified to his high intelli- 
gence, quite unconsciously demonstrated in this same statement 
the derangement of thought, in fact, the disorganization of the 
personality when he said: “It occurred to me that they were very 
simple questions for a student with the ability of young Leopold 
to ask.” 


git has also been said so often that the two boys are sane, 
because they had prepared their plan so well beforehand and 
carried it out so cleverly + in detail that scarcely a trace could be 
found. If I touch upon this point here, it is only to show that 
also intellectually prominent catatonics can no longer think their 
thoughts out to the end, for they are unable to see anything as 
a whole, to look over an entire field. 


Was it such an absolutely safe undertaking to carryout a 
homicidatassault in the automobile, in a fairly crowded street, in 


a cen kart cts is ae AA NEO RNAS Aint 











*It would still be reasonable to deny at all that he was Leopold, 
saying he might be merely his double-gaenger. But just as did Leopold, 
so do numerous catatonics behave themselves, asserting to the physician 
that they have been “mistaken” for the persons, the names of whom they 
bear. Besides, a normal or psychopathic individual would scarcely react 
at all to such an event. 


+ Compare with this point what we said, page 31. 


54 
bright daylight ; then to drive with the victim before a restaurant, 
get out, and stay a while on the spot? 

Does it in any way bear witness to a precaution when the in- 
strument, on which the traces of blood—that can always be proved 
as human in origine—were not even dried, was thrown out of 
the window of the automobile, in the neighborhood-of the boys’ 
own home, into the middle of a crowded street, so that—as actu~ — 
ally happened—“it was immediately picked up and handed over 
to the police’? ; 

Before the dead body was put into the culvert, the face had 5 
been treated with an acid to make the features unrecognizable. j 
But does it mean catition if the > head has been laid in water deep p 
enough in quantity to wash away the acid; and was it an - oblitera- : 
_tion_of traces when the feet were left howe from the culvert, ~ 
so that they must be noticed at once? 

Not for the sake of having an alibi but in order to prevent — 
that an opposite proof should be brought to the court, Leopold 
could so easily have taken his automobile from the garage and — 
“parked” it anywhere for the necessary time. Thus, his own 
chauffeur would have been unable to state that Nathan could 
not have driven his automobile, because it was that afternoon in 
the garage. | 

And Loeb’s conduct after the deed or even the mode in which 
the money would have to fall into their hands—does all this not 
witness lack of critical sense; yes, weakness of the judgment? 


ee a ee 














* *K * 


Little is to be said concerning the behavior of the two patients 
in the courtroom, inasmuch as neither Leopold nor Loeb has © 
taken the stand in his own defense. What a pity! I harbor the 
conviction that if the youths had spoken freely and unfolded 
their thoughts, especially during a cross-examination, the chaos 
which reigns in their minds and the total destruction of their per. 
sonalities could have been brought to light. Certainly it must be 
acknowledged that persons of this sort are not to be counted upon. 
On the one hand, they were picking scabs, which must startle 
even the prejudiced, but then they suddenly spontaneously refuse 
any information and sink into apparent indifference. For, although 


55 


their conceptual faculties as such need not be disturbed as yet, they 
ere unable to break the compulsion which their disease has laid 
upon them. Psychiatrically, we denote this phenomenon as nega- 
tivisth,* of which I have given some proofs (page 12). It is as- 
sumed that in the inner life of these patients there is present an 
unbiddén resistance toward all notions. Thus, automatically, an 
Opposite idea obtrudes itself against every conception coming from 
inside or out and blocks, or prematurely interrupts, the carrying 
out of any purpose. 

Fe that as it may, it is an actual disadvantage that the public 
had no opportunity in the court to convince itself of the indispu- 
table mental disease of the young men. And it is precisely the 
behavior of Leopold and Loeb before the court which has led to 
wrong conclusions and has created the bitterest feelings toward 
them on the part of the people. It could be reported only that 
“nattily dressed, clean-shaven, with hair carefully parted and 
slicked back, Leopold and Loeb come every day into court with 
their bviliffs and casually resume their assumed role of interested 
spectators of their trial. They posed for pictures and conversed 
good-huimeredly . . .” Or: “Throughout the sessions, they 
had smiled and at times laughed outright as witness after witness 
passed through the box. . . . Smiles remain as exhibits have 
been offered. . . . They have maintained a gay demeanor 
ever since the day that they confessed. They smiled when they 
confessed. They smiled when they said, ‘Guilty.’ They smiled as 
the State’s evidence was presented. Then, yesterday, when their 
own alienists reported that they were sane(?), they smiled again. 

They were nonchalant and enjoyed their own joking hu- 
mor. ‘They smile and jest at the proceedings, in which their lives 
are the pawns.’ Only seldom, “they appeared disconcerted, for 
periods motionless, disinterested.” 


——— « ‘ 

*T migit designate as a foresteve of negativiSm a condition in which 
those concerned see only the opposite of everything, and where any 
question merely arouses additional ideas. I have also described a patient 
who confessed that he understood everything only approximately and not 
as one should grasp a thing. What he knew was “purely incidental,” had 
solely an “accessory value.” And what he remembered he did it only 
acoustically or optically “without grasping the content.” His teacher, 
who had prepared him for the university, expressed himself very 
significantly in regard to him when he said: “If you come home and put 
the key into the keyhole, you would be trying before you open the don: to 
find out the chemical constitution of the iron.” 


56 


But the people on the outside were never satisfied. If the boys 


laughed and had a good time, so were they—as some newspape=s — 


have expressed it—the coldest-blooded mortals in the world. If 


their disease let them fall into a more apathetic, indifferen* State, — 
this same public raised an outcry against them, because ‘f their — 
“disinterested attitude.” Yet the ground for the pect... 1c 7 


havior of the boys should have been examined. 


“And the answer was sent to the world last evening te tue 
question that has burned the lips of millions of persons chrvig?- 
out the country.” 

Loeb, informed how displeasing was the way he acted it cet, 
asked—and again he laughed outright !—“What do they was nu 
to dor” They want you to act naturally. “That is sist csacty 


what I am doing,’ Loeb returned. “TI sit in the courtroom an% | 
watch the play as it progresses. When the crovy laugh I 4 


laugh. When it is time to be serious, I am that... Tama 
spectator, you know, and I feel myself as one. You <i.nfll che ® 
people on the outside there is no faking or preter.i..~., 1 Rave © 


watched you reporters across the table; and you ‘Jagan, simile, 
yawn, look bored, and all the other things. \VYuy should I be 
different?” 


And Leopold said: “People have wondered why I could be- 


lieve the things I do. No one has ever been able to understand © 


my philosophy of life. They said I am crazy. Well, perhaps 
they are right.* But everything I believed’ on the outside I still 
believe. My philosophy is hard to explain, and my code of living 
is radically different from that of others. But, damn it, whatever 
comes about, I will always believe I am right; I still and wilt 
always think that murder is no crime: Pegple say that I am 
bluffing when I say that I am not afraid to die. Tiey think it 
is just a game to be. used in beg*ing the law, but let nt. say to 


you that I have absolutely no fear of death. They wonder why — 


I have shown no compassion or remorse for the murder I aided 


in.tf Why should I? It was not wrong. If only I had an op-— 





he Sach clear moments during which Leopold rightly judged upon — 
“his mental condition were extremely rare. Mostly, he regarded himself ‘ 


as totally sane. 
*+This does also show that Leopold has not executed the deed. 








57 


portunity to talk with every person in the world about my beliefs, 
I might be able to get them to see my points. The mode of living 
on which I have based my life is with me and tends to support 
me here as it did when I was the carefree boy on the outside.” 


Are these arguments not convincing enough from the stand- 
point of Leopold and Loeb? Is it not made plain that if these 
youths were sane they would easily adapt to the wishes of the 
public and, at need, assume remorse and contrition, especially as 
they ought to know that it is a matter of life and death to them? 
When they behave as they do, they do it for this reason only, be- 
cause they cannot £ do otherwise, and their present nature compels 
them to act thus. We know full well, how difficult it often is 
to demonstrate the psychic manifestations of a given person as 
product of a diseased brain, yet, if we will succeed in this proof 
we must emphasize essentials and stress those points which can 
enlighten everybody. Positive results are scarcely to be reached 
through—in some directions interesting—psychoanalytic reflections 
or any discussions of endocrinological matters not yet ripe enough 
for the public. On the other hand, of course, analogous discus- 
sions are not to be rejected by such counter-opinions which can 
never satisfy a specialist as they derive from out-lived maxims, 
old-style theoretical speculations and routines. Only the adequate 
interpretation of the anamnesis, the peculiarities and strange 
characteristics, already early perceivable, the signs to be expected 
from the intrapsychic disharmony, furnish tangible points for 
judging the conditions before us. 


Besides—let us repeat it—the individuality of the person con- 
cerned must be considered above everything. In several works,” * 
we have referred to the dissimilarity in the clinical manifestations 
of people with different intelligence and culture and have refrained 
from measuring catatonics of high mental standing by the same 
rule as low or moderately developed persons. This has been 
recently emphasized by Kretschmer ** also: “The flowering of 
the inner life of catatonics § cannot be studied in peasants. Kings 
and poets are none too good for this.” Here, only in other words, 
the kernel of the matter is expressed. I have yet to see the aver- 





% Compare pages 23, 28, 86 and 108. 
§ K. speaks of shizophrenics. 


58 


age patient who would bring before our eyes the manifold char- 
acteristics of his divided personality in such evident manner as 
these two youths have done. The spectator Loeb cannot have any 
concern for the Loeb who is on trial; and that Leopold who shows 
himself bare of all emotion is a totally different person from that 


Leopold who has great feeling for his father and brothers, and — 


who, full of remorse, would beg to be disinherited. 


In normal persons pleasurably toned ideas create a feeling of ‘ 
joy, while unpleasant thoughts are centers of distress. Now in ~ 
catatonics, however, the psychic connections have been destroyed, — 
so that the adequate relations between the ideational and the feel- ~ 
ing life are wanting. This is the source of the emotional indif-— 
ference and apathy ; thus the unconcern and lack of interest toward ~ 
the environment must be explained; in this way arises the in- fe 
sensibility in regard to his own person. In presenting the sympto- ~ 
matology, we have already said (page 25), that if these individuals — 
tell of their experiences and conditions, or listen while others © 
speak, they do it as spectators, without giving any sign that they ~ 


are the very center of the narrative. The catatonic who is only 


in the first stage of development, even when he has no delusional — 


ideas, will himself relate, or listen to others while they tell, the 
most gruesome events with the greatest calmness and indifference ; 
just as the already far-advanced insane patient informs us day 
after day, with an unchanging countenance and with the same smile 
that he is subjected to the most fearful tortures, that boiling milk 
is poured into him, all his internal organs are torn out, that they 
beat him till the blood flows, whip him, trample on him, that he 
knows they will cut his family in pieces, bury them alive, or 


burn them. This apathy of the affective life, which results from ~ 


the intrapsychic disharmony, this loss of concern for one’s own 
person, belongs to the very first, to the most important and yet 
most frequently neglected signs of catatonia. 


How does it happen that this constant, so convincingly valu- 
able diagnostic symptom is only seldom noticed and properly esti- 


mated? Plainly, that is due to the fact that catatonia develops as 


a rule quite stealthily and the patients already from earliest youth 
are pictured as odd, shut-in, unruly, or brooding. At puberty, they 
pass with their peculiarities as strange; and, so far as no dangerous 


manifestations or criminal tendencies appear, they fall quite slowly — 





59 


and gradually into deterioration, the degree of which can be so 
variable that the opinion of the psychiatrist does not seem to be 
required. 

Besides, catatonia primarily affects always the emotional life, 
and the results of this destruction may escape detection for a 
long time, since the ability for daily tasks suffers less from the 
annihilating influence. The patients in this respect may retain 
enough capacity to be exercised in a limited circle successfully to 
maintain even the struggle for existence. A jurist who, because 
of his mental illness, has slipped down from his own pathway earns 
his bread as a clerk in a lawyer’s office; the highly skilled fine me- 
chanic is satisfied with the most ordinary work of a locksmith; the 
very talented painter lands in a common school as a teacher of 
drawing ; and the virtuoso, with all his genius, ends his career as a 
player in a saloon or a dance hall. But they are all satisfied with 
their lot and have no sense of need to lift themselves to their 
former station. 


The previous life of our patients is also in full agreement with 
the present situation. Leopold and Loeb, like so many other 
catatonics, suffered disaster very early, for they promised so much 
more than they have fulfilled. 


* 


Richard was a weakly child. He increased slightly in strength 
until of the age of nine, after which he grew strong and hearty. 
Since he was ten years old, he has not been in a fight. He was 
especially afraid of losing his eyes or of injury to his legs, and 
he-was afraid of being beaten up by a gang of boys, such as at 
camp. At the age of twelve, he stammered some. At fifteen, he 
had an automobile accident and suffered a concussion of the brain. 


For the last two or three years, he has had tremors of the face. 
Richard’s father was tender to his boys, fair and just. He 

never used corporal punishment. He is opposed to the boys’ 

drinkiny. The father’s wish was law. Richard respected it. 


, 60 


Richard has always been inclined to self-pity. In his quar. 


—— 


rels with the family, he has always felt that he was right; but with © 


others he has often realized that he was wrong. 


At the table, Richard often would boast and manifestly seek 
for praise, even when company was present. From eight to” 
fourteen, he was under the influence of Jack M., who since has 


become a forger and is now serving time in the Federal peni- 
tentiary. 

There were several phantasies, and Richard would en 
himself in jail. He has the idea to be the “master mind,” 
clever at planning crimes that he could escape from the rel 
detectives in the world. 


Richard took, when nine, from a boy who lived next door, 


about one dollar” He-hid it under the roof of a shanty in his own 


backyard. About this time, he and another boy had a lemonade 


and candy stand for one day. While the other went to lunch, | 


Richard took the things home and hid the toy cash register with 


the money in it in the grounds. When fifteen years old, he dis- | 


covered that the keys to his mother’s car would fit any of the 
same make, With another boy, at Richard’s initiative, a car was 
stolen and used to travel about to send in false fire alarms. Then 
Richard stole all he could conceal, even things he did not use. In 
November of 1923, Richard robbed his own fraternity house with 
the assistance of Nathan. On their way home, they got into a 
heated argument; their friendship threatened to collapse, but after 


several hours they came to an agreement that was to last until 


Nathan went to Europe in the summer of 1924. The companion 
agreed to be absolutely under any orders that Richard might give 
except ridiculous commands and things that would cause trouble 
or friction with his family. 

Two years ago, Richard shadowed his uncle; he wore a mask, 
and just at the front doorstep of the uncle’s home Richard said to 
him, “Hold up your hands!’’; but the uncle replied, “Run along 
home, Dick; don’t be foolish.” 


Richard was a marvel in deceiving his parents, friends, and 


teachers. At no time did he ever experience the slightest feeling 


of guilt or remorse for lying. His lies were practically always 


successful, since all considered him a very frank and truthful 


lad, and his appearance was not one of guile. 


61 


He boasts also skillfully. Recently he told a girl acquaintance 
that he was a bootlegger and had a fight in a saloon, showing his 
shirt, in which he had shot a hole. 

Richard omitted any account of setting fires. When con- 
fronted with the fact, he did not appear in the least embarrassed 
and said: “Oh, didn’t I tell about that? It was one of the 
things I meant to tell; I didn’t intend to omit it.” 

Richard-.has no interests in life except his criminal ones. He 
has no ambition, no aspirations. He is lazy and has no real in- 
terest in study; he began many things but never finished them. 

He says that he will tell a lie with no compunction whatever, 
and he is completely dishonest. He feels that he has been much 
less popular during the past year and has contemplated suicide 
a number of times. 

Richard says he is comfortable now in jail and is living his 
dreams. He is happy behind the bars and has no complaint 
to make. 

Richard’s manner was extremely polite and courteous. He 
was noted for his kindness, for his supposed affectionate nature. 
During the investigation, his manner was extremely convincing. 


* 


It does not appear clearly enough from the just-sketched life 
history of our patient when his entire nature turned about; that 
is, from what point of time on his actions ought already to be 
considered the result of manifest disease. For we must, without 
any question, admit that the phantasies, the petty thievings, the 
lies and pseudologistic offenses of which Richard has been guilty, 
frequently enough are present in children of his age who later 
never come into conflict with the law. We may consider such 
events as pathological when they extend beyond puberty. For 
that shows that the associations and connections of the psychic 
elements, the inhibiting corrections which, under normal condi- 
tions, become established at that time, are lacking or only very 
imperfectly developed. As long as the brain centers work without 
check, the phantasy activity of the child may remain lively, and 
he will continue to reproduce vividly things which he has experi- 
enced hitherto in his short existence. 

Children, because of their ready divertibility, observe poorly 


62 


and are therefore subject to far greater falsification of memory 
than adults. | So also, in their reproduction, they fill out and cover 
over the gaps and thus permit their phantasy to gain greater 
power. However that may be, it is difficult to show from the 
symptoms found in Richard’s anamnesis up to the fifteenth year 
why he had to fall into the path of crime. Of course, this does 
not exclude the bringing to light through a specially directed in- 
vestigation factors which would permit us to recognize much 
earlier the catatonic basis of the symptoms. It is striking that. 
this ten-year-old Richard, for example, “who was quite reckless 
in regard to personal safety in other ways,” at the same time 
“has not been in a fight, being especially afraid of losing his eyes 
or of injury to his legs or of being beaten up by a gang of boys, 
such as at camp.” Are these not unmotivated, absurd, hypo- 
chondriacal ideas such as we find so often in the beginning of the 
juvenile insanity (hebephrenia), that means, in catatonically dis- 
posed children? | 

So much, however, is certain, that at fifteen years of age 
a boundary is passed, and a new epoch begins to make itself 
known in Richard’s life. The symptoms progress so clearly that 
the condition can only be understood from now on as morbid and 
not otherwise than in the sense of catatonia. ‘Two factors active 
at this time are to be recorded; namely, puberty and the auto~ 
mobile accident. Concussion of the brain and revolution in the 
entire organism worked together to call forth a mental situation 
which, in its results, was as disastrous as the “pact”? which the 
boys had concluded already in their disease. It is true that an 
criminal psychopath will steal, rob, and even murder, but to 
venture a capital crime with such motives and to carry it out in- 
this manner would be possible solely for a man who is no longer 
master of his mental faculties. There are kinds of actions which 
can be explained only as occurring in the insane, and there are 
crimes committed which, like this one before us, seem plausible 
merely in criminal catatonics. | 

At any rate, Loeb also was unable to guide his life in the 
right path and to establish for himself the proper social position. 
Besides, he gradually was overpowered by ideas which, in the 
period that followed, took on such monstrous forms that from 
the psychological standpoint they could in normal persons no’ 


63 


longer be comprehended. To this must be added the intrapsychic 
disharmony, contrasts, and signs of destruction of the personality 
already demonstrable for years; further, the great inconclusive- 
ness, indeed, the complete absence of judgment, the absolutely ego- 
centric nature, the incalculability of action, the total indifference 
in regard to the future and full satisfaction with the present 
situation, as well as other already depicted marks that assure the 
diagnosis of catatonia. 


While Leopold weighed about six pounds at birth, he spoke 


a word when only rave and one half months old. During his 
youth he was precocious. His intelligence was far ahead of his 
age. He learned languages easily and loved art. He was re- 
markably clever and much interested in medicine. If he were 
not going to be a lawyer, he would like to be a doctor. He was 
stubborn, inclined to be seclusive, and so extremely_selfish that 
he would not cross the room to save somebody’s life. He en- 
tirely concealed his feelings from others and did not make friends 
very easily. He showed a great fondness for his mother, who 
is now dead, and whose grave he often visited; but he did not 
seem willing to admit there was any extreme attachment to her. 
His mood was rather characterized by dissatisfaction and criticism 
toward himself and others. He was boastful in his manner and 
did not appear to care what people thought about him. He was 
inclined to make cutting and sarcastic remarks and sneer at the 
lesser ability of others. Having always a marked feeling of 
physical inferiority in comparison with his comrades, Leopold 
quickly realized that he was their mental superior; and this he 
emphasized in every possible way, assuming a proud, intolerant, 
and contemptuous attitude towards them and endeavoring to show 
his superiority wherever possible. 

When five years old, Leopold began to construct phantasies, 
which he indulged in before going to sieep at night. HHe_finally 
fitted his companion as the king and himself as the slave—a role 
that he also previously preferred to play in his phantasy. 



















O4 ' 


As a small boy, he once took fruit from a sestaurant, then 
some stamps from the albums of his friends to add to his own 
collection. He also took some of his brothers’ neckties and 
traded them for cigar bands he was collecting. 

About the age of fifteen, he began to use alcohol and to cheat 
at cards at the suggestion of Richard. 

“Leopold never felt just right in his parents’ home. He 
wanted to leave it, asserting that he would support himself and 
set up a happy home of his own. He has looked down on women — 
and despised them, because he felt them inferior intellectually.” 
Nevertheless, he intended to conclude a marriage, against his” 
father’s will, not entirely in his own class. He has complained” 


at home, of the contrasts in the sides of the family, and expressed” 
himself favorably only in regard to his dead mother. His soul, 
stood above his environment, and he would submit to no limita~ 
tions. He would go his own way, even if he offended against: 
convention.” 4 

Leopold often argued that he existed as an individual with” 
no responsibility, anything that gave him pleasure was right. There | 
is no such thing as an inherent right and wrong, and justice has 
no objective existence. The only wrong he could do was to make” 
a mistake, and his happiness was the only thing in life that mat-7 
tered at all to him. Making up his mind to commit a delict was” 
the same to him as making up his mind to eat a piece of pie for 
supper—whether it would give him pleasure. { 

He held life dear, because he believed “he had an important 
work to do for the world.” He always feared physical pain but 
not death. | 

Several times last summer he had experience of a blurring 
which looked to him like a white hearse in the sky, but he tends 
to minimize the whole thing. Once he imagined that he saw 
the tail light of an automobile in front of him, when there was 
nothing there. j 

He has carried out a number of superstitious ideas. For 
example, he always crosses his fingers when passing an under- 
taker’s shop. He always avoids a black cat, and, if he sees one, 
he spits over his left shoulder. He would never allow any one 
to be the third to light his cigarette from a match. 


65 


Concerning the deed, Leopold affirmed that he agreed to it 
according to the terms of their friendship. Later, he was a little 
disturbed by the behavior of his companion, who would discuss 


the crime publicly at every opportunity and would offer all sorts 


of theories about it. “I became rather apprehensive,’ Leopold 


i 


said. 
*k 


When we try now to discuss Leopold’s case, we must also 
here pass over the phantasies and the petty thievings, as they are 
irrelevant from the diagnostic viewpoint. In Richard’s case, we 
could not from his statements and the anamnestic data, more 
precisely determine the turning point of his life. But Leopold 
has revealed that moment from which his character was trans- 
formed: “I was taught conscience until I was eight years old, but 
after that time I drilled conscience out of myself.” Thus early has 
he, or, more correctly, the disease, already torn from him what is 
indispensably necessary for a social existence! No wonder, there. 
fore, that his emotional “tests” set him back today at about this 
age. > 

Very well-endowed, although with hardly a glimmer of 
“genius,” which, incomprehensibly, is again and again attributed 
to him, Leopold has gone on developing intellectually. Yet what 
has he accomplished, and where are the fruits of his brilliant 
mind? Not too much stress is to be laid upon his ornithological 
knowledge, even if this has some scientific importance; for in. 
dividual abilities often enough have been demonstrated not only 
in imbeciles but also in idiots. What else has Leopold achieved? 
Something in jurisprudence, perhaps, where he mixes intelligence 
with “very simple questions”? Or in newspaper writings, where 
he published some articles that ought to be witty, but are in 
reality empty, yes, absurd? Conscience is “drilled out,” but in 
its stead are “drilled in’ hollow phrases, undigested philosophical 
conceptions, misunderstood principles, superficial convictions, im- 
mature persuasions, and sheer feebleminded megalomaniac ideas. 

Egotistical, insolent, selective of his company, sensitively cool, 
lacking any ethical feelings, Leopold looks down with pride and 
scorn upon his fellowmen, whom he has considered as something 
intellectually inferior, and to whom he has shown his superiority 


by a sarcastic, contemptuous, intolerant bearing. Moral prin. 
ciples? Laws? No man need trouble himself about them who has 
been called to greater things and has “important work to do fox : 
the world.” 

It has already been said that Leopold, according to our con» | 
viction, is very indolent and no longer possesses enough initiative — 
to rouse himself to independent action, especially of a more im.) 
portant sort; although he—we see this in the criticisms of the 
behavior of his partner after the deed—in some directions ap-— 
pears purely intellectually capable of judgment. In agreement 
with this is the fact that in the double relationship to one another — 
not he, but Loeb played the leading role. 


We see therefore how easily Leopold fell under the influence 
of another, and how suggestible he was. That is not to be 
wondered at, since, in any case where feeling is injured to a 
high degree, and the orderly control of the mental functions is 
wanting, suggestibility and persuasibility to action must be 
present; because the consciousness of one’s personality, which 
should give direction and stability, no longer comes into play. 
Besides, such individuals find in themselves no halting point, and 
they miss any firm convictions. “For this reason, catatonics readily 
adopt the thoughts of others, which they consider as their own. 
Like children, such patients submit to good or evil influences of 
others. As long as they remain under the guidance of their 
teachers and superiors, they make an effort to give satisfaction to 
them and may still be able to do useful work. 

At any rate, we see that Leopold also had no reasonable mo- 
tive nor an interest in the carrying out of the deed; that, con- 
sequently, he had been only a “go-along-with man (Mitgaenger).” 
For it would be merely an unmotivated supposition that he wanted 
to seek adventures and money to spend here or in Europe, trying 
his luck at cards. Seclusive people, vegetating “in phantasies,” 
never plunge into the whirl of life to enjoy it in gambling casinos, 
race courses, cabarets, or rendezvous houses. For the same rea- 
son, both boys have shown no response to the allurement of 
“oilded youth,” and as little the tendency of the bon vivant. In 
a superman of Leopold’s sort, such things attain no noteworthy 
significance in their, life; and the card playing as well as the 
drinking, in themselves little praiseworthy habits, especially in 


67 


such early years, have not reached with Leopold and Loeb the 
degree they would have attained in psychopaths of the same social 
class. al 

The intention of going to Europe, moreover, was already 
conceived before the plan for the carrying out of the deed was 
formed. Leopold had stipulated at the conclusion of the “pact”— 
which preceded the thinking out of the plan—that the contract 
would be binding only until his departure for the Continent, and 
he himself wished to be held by it no longer than to this period. 

It seems superfluous in this case to go more deeply into the 
ground of the diagnosis. The latter is already made certain 
through Leopold’s make-up, through the early emotional death, 
the great weakness of judgment, the countless discrepancies, 
through his delight in reforms, the compulsive actions (page 64), 
the mannerisms and peculiarities, the echoes of visions and il- 
lusions. It is also worthy of note that during the investigation 
Leopold insisted that the expert call him by his college nick- 
name. Such harmless whims complete the picture of catatonia. 

So, then, the whole of Leopold’s relatively short life is only 
the expression of this grave illness, which, whether, we designate 
it “mental disease,” “psychosis,” “insanity,” or “catatonia,” in its 
elemental inevitableness must lead to this tragic result. And sup- 
posing it is true—personally I am of a contrary opinion—that 
“science has not yet progressed sufficiently to be able to state the 
exact cause of Leopold’s sickness,” yet it has taught us to weigh 
the symptoms of the disease properly with one another and to 
interpret them correctly. The conceptions and the names of a 
psychosis may differ, but not its manifestations. Over twenty 
years ago, Kraepelin in Java and I in Central Asia made com- 
parative investigations in men of low cultural grade; and, quite 
independently of one another, we were compelled to the publica- 
tion of the same results. As is only to be expected, today I can 
confirm that the average catatonic throughout this country ap- 
pears just as he does in Europe or Asia, and that the intellectual 
catatonic in America provides a picture just such as we are acy 
customed to see in analogous patients on the Continent. 


; 
We will discuss briefly here the question whether the automo. 
bile accident of which Loeb was a victim in his fifteenth year, 
and which resulted in concussion of the brain, could have called 
forth the disease. Naturally, this question is to be answered only : 
in the negative sense, especially since we have found earlier patho- — 
logical symptoms in Loeb. It may be, however, that we can speak — 
here of an agent provocateur and admit that the disease, because of 
the accident, could have come forth from its more latent state.” 
Experience teaches that under the influence of the most varied 
external or internal factors, the morbid signs may take on greater 
proportions. 


a 


 >& 


el a Ee 


Besides, we have not to forget that just in the period of life 
which we call puberty, even without a manifest shock, but as a © 
result of the changes that normally occur in every organism, an _ 
evident inclination to accentuation and potentializing of the symp- 
toms makes itself felt. It is certain that especially at this age 
psychoses tend to break out acutely, taking on then a chronic, 
progressive course. 

We know that in the normal child, with the maturing of the 
body, the life glands must come into action, and that this results 
in a change of the psyche, which now becomes transformed from 
the infantile to the adult. The brain gains the mastery, takes 
over the leadership in everything, creates new emotional rela- 
tions, permits new impulses to arise. Inhibitory operations, which 
formerly were performed but little or not at all, gradually extend 
themselves, controls come to their proper rights; whereby every 
stimulus releases instead of the infantile, more or less dispro- 

portional, yet already normal reactions. The unhampered child- 
ish condition recedes more and more, and the inhibitory correc- 
tions make themselves felt. This evolution, however, is fully 
and exclusively dependent upon the normal functioning of the 
life glands. If their maturity is delayed or totally inhibited, the 
individual grows in body and attains his size, but psychically he 
remains upon the childish level and may maintain an infantile 
attitude throughout life. | 

Furthermore, all the organs of internal secretion stand in 
closest functional relation and mutually influence one another. 
The failure of one gland produces faulty functions in organs 
which are dependent upon the stimulus that should arise from 


69 


those glands. This stimulus is brought about through the so- 
called hormones; that is, stuffs which are produced in the organ 
itself and given off to the blood, being carried through the circula- 
tion to the different portions of the body. 


The above brief remarks will point out how pernicious the 
period of evolution and of development may become—this per- 
tains, too, to the climacteric, which means the period when the 
sexual function declines and disappears. In their relation to 
mental diseases, however, these periods of life come into con- 
sideration only as final causes, for they bring, so to say, the last 
drop, which makes the beaker overflow. 

If, therefore, even a more or less normally functioning or- 
ganism, because of the changes taking place within, may be 
diverted from its right course, how easily must an individual fail 
who enters upon this period of life with inferior or quite inert 
glands? 

In our first study,® we have noted the clinical proofs on the 
ground of which the deterioration psychoses of adolescence must 
be referred back to a disturbance or failure of the action of the 
life glands. Two years later,’ catatonia was derived from an 
anaphylactic autointoxication due to a primary deficiency of the 
life glands caused by an intrasecretory disturbance. We cannot 
speak here in detail but will limit ourselves to the repetition of the 
most essential. 

“The life glands consist of two different portions,* the gen- 
erative and the parts of inner secretion.12 The latter, represented 
by the so-called Leydig cells, must remain active until the death 
of the individual, while the generative portion in time disappears 
entirely. Furthermore, the degree of development of the Leydig 
cells stands in closest connection with the period of life. In the 
embryo, these cells are represented in an enormous number, in 
the newborn, in rich quantity. At the beginning of puberty, they 
must increase significantly in number, to become more scarce from 
this time on. ; 

“We can also prove experimentally that glands form hor. 
mones already during the foetal life. Failure on the part of 
the Leydig cells in the embryo results, we believe, in certain 





*Both totally different parts we establish also in female life glands. 


x 


70 


forms of idiocy; it causes, furthermore, changes in the en- 
docrines that lead later to the development of catatonia. 


“The very frequent appearance of catatonia in the period of 
puberty would have its basis in the fact that at this time ** special _ 
demands are made of the internal secretory portions of the life 
glands. 


“Tf the multiplication of the Leydig cells, which under normal 
conditions must take place, does fail, or when the produced hor-— 
mones become qualitatively changed, then the entire organism 
will be toxically affected, through the medium of the circulating 
blood. Besides, we can think that the products of inner secretion 
of a certain cell complex, though they may act upon the whole 
body, respectively, its different parts, have to one organ still a 
quite special affinity. It is striking that already Henle paid 
attention to the morphological similarity of the Leydig cells with 
nervous structures and that Huxley has directly identified the 
above-named cells with nervous elements. This would explain 
the elective inclination of the Leydig cells to influence the brain 
cortex. 


“More and more the conviction presses itself upon me that we 
must, so far as the primarily diseased organ comes into question, 
let slip the point of time in establishing the proofs of its dysfunc- 
tion. It would be against the intentions of nature if immediately 
after the failure of but one organ, for instance, of the life glands, 
at once demonstrable psychic symptoms should appear. Plainly, 
the organism first enters into a hard struggle and yields, but only 
when all attempts to restore the equilibrium have been in vain, 
As a result, before morbid symptoms become evident, such glands 
which have to replace the primarily affected ones or those whose | 
activity is dependent upon the hormones of the organ originally | 
fallen into dysfunction must be more or less drawn into sympathy. 
The more strongly the glands have suffered, however, through the 
pathological processes, so much greater disturbances will they 





ui 
q 


+ Heredity means for us parental transmission of sound organs of 
internal secretion, first of all, the life glands. Bad heredity means there- 
fore inheritance of more or less pronouncedly deficient glands, which - 
are already defective in the embryo. This defect can in time be replaced 
and compensated by other glands, so that the congenital morbid process 
need not necessarily go on and lead to secondary dysfunctions which - 
may result in psychoses. 


71 


cause in the entire body, so much more prolific will become the 
psychic symptomatic picture. 

“In catatonia, the life organs first fail to perform their duties. 
In order to compensate for this loss, springs into the breach the 
thyroid; to which, beside the specific effect, is also ascribed a 
general detoxic activity. If the thyroid is not able to make good 
the injury, it falls itself into dysfunction, and then the hypophysis 
appears as a helper in time of need.= It is evident that in a body 
with a very defective disposition one gland cannot perform duties 
for an entire system. The further result is the failure of the 
brain cells, which appears as the fourth stage in the development 
of the process tending to cerebral manifestations ay 


We need not speak in detail.of the bodily condition of the two 
patients, since such findings could in analogous cases attain for 
the present but little significance in the judgment of the court. 

Things shape themselves differently if we consider these 
questions from the point of view of the internal secretions just 
discussed. In truth, it does not admit of the slightest doubt that 
in the development of catatonia the one decisive factor must be 
attributed to glands; but the way to prove this is not yet so finally 
established that all that takes place in the body can be explained 
before the court in a convincing manner. Of course, not every 
glandular disease leads to insanity. When, however, endocrine 
manifestations are made evident along with the psychic ones, the 
scientifically thinking physician is forced to accept an inner con- 
nection between these two facts; while the experienced clinician in 
this field will be in the position to establish what is cause and 
what effect, which glands primarily and which correlatively— 
that means, by sympathy or antagonism—have become defective. 
Endocrinology, even today, is a science which stands upon as sure 
a footing as, for example, neurology, or other distinct branches 
of internal medicine. There is no catatonia without severe en- 
docrine changes, which are most markedly developed in the life 





- t All these questions we can prove by clinical and experimental facts. 


glands. We can demonstrate it with certainty, however, only 
after the death of the patient, since neither researches in meta-— 
bolism, so far as carried out until today, nor x-rays have yet in 
any case given us absolute sure signs. Positive findings, certainly, 
we have to make use of, while negative ones still do not exclude 
a pathological function of the glands. The objections brought — 
against Abderhalden’s method are well known to me. I believe,” 
nevertheless, that until today, especially the so-called optic in-— 
vestigation, will in the best manner manifest the endocrinous ; 
conditions of the single organs as such. 


When I made catatonia dependent upon a primary impair-— 
ment of the life glands, I assumed in the blood of such patients 
stuffs directed against the generative organs. These stuffs were 
later demonstrated by Abderhalden as “defensive ferments.” Then ~ 
it was established that catatonics not only have products in their 
blood which point to a dysfunction of the life glands, but also stuffs 
_that originate from the thyroid, hypophysis, adrenals, and other 
organs. This fact is quite understandable—and in accordance _ 
with our conceptions—for we have postulated that psychic symp. 
toms first make themselves visible when the entire glandular sys. 
tem—or at least four endocrines—have become disabled. | 


That catatonia depends upon disorders of internal secrete 
can be shown also through the favorable and very encouraging ~ 
results obtained in a great number of cases from the treatment of 
patients with glands. Despite all above-mentioned. facts, we 
must, however, especially before the court, explain the catatonia 
as a chronic mental disease and derive its existence first - 
the psychic picture. 


ok 


The question of the intellectual abilities of Leopold and Lt 
must also be touched in a few words, inasmuch as this factor is 
usually incorrectly valued by the public. 

y 
| 


What we said before does sufficiently prove that it is a mis- 
take to draw conclusions as to the real worth of a person and_ 
the form of a psychosis from the intellect which is preserved. | 
The evidence of even high intellectual gifts speaks as little against | 
catatonia as, perhaps, memory defects in themselves would justify 


73 


the assumption of a psychosis.* or the mentally sound forgets 
also when the Punic wars or other historical events took place; 
what a certain philosopher, scholar or poet, emperor, president or 
governor, general, politician, or mayor was called; how a certain 
arithmetical, respectively, geometrical rule reads; what this or 
that chemical and physical law, such or another juridical or philo- 
sophical definition says. When, however, some one over whose 
head the death blows are ringing “is in a joking mood about his 
dress”; when in the most serious moment of his life, instead of 
the Damoclean sword, he “notices the color of his hat’’; when he 
“was nonchalant, concerned only with the manner in which re- 
porters would describe his clothes” ; when he laughed, enjoying his 
own “joking humor,’ and immediately thereupon “appeared un- 
concerned, frequently sat virtually motionless for periods of ten 
or fifteen minutes during the recital”; or when the other boy 
also “was almost stolid in his indifference”; when “he frequently 
adjusted his stylish bow tie, moistened his lips with his tongue, 
and picked at specks on his sleeves,’ but soon afterwards was 
“pale and an almost startled expression widened his eyes and 
dropped his jaw”; or if an “extremely polite and courteous” 
young man, who has been accustomed to good circumstances and 
opulency, having intercourse in better social circles, is comfort- 
able and happy in a prison cell and enjoys the company of crimi- 
nals; then are these, for us, well-known pictures, states, which 
suffice to support the diagnosis of catatonia, even if no disturbance 
of intelligence manifests itself. Besides, we must expect that a 
psychiatric investigation at this stage of the disease would always 
bring to light still other characteristic marks of catatonia. 


Even the circumstance that Leopold is said to have distin- 
guished himself in ornithology does not refute our diagnosis. In 
this disease most of all, purely theoretical knowledge may remain 
undisturbed for years and decades in the person afflicted ; especi- 
ally since in catatonia we have to do not with an uncultivated and 
unfruitful tree, but only with one ravaged and devastated, so 
that, at times, fairly large remnants may be gathered together. 
And, then, what does onesided knowledge signify? Did per- 
haps the fact that the ten-year-old boy (described on page 123) 





* Compare with this point pages 25-26, 39-40 and 120. 


74 


was a famous expert in beetles and a geographer save him from 
the characteristic terminal deterioration? Have we (pages 36-39) 
not clearly shown how much catatonics may achieve in scientific, 
artistic, and literary direction before they go to ruin? One of 
my patients, who deteriorated very rapidly, during the illness 
already evident wrote a drama which Reinhardt produced in his 
theater. I have published also verses made by catatonics—one 
of them wrote in twelve languages—of which a Heine need not 
have been ashamed. And I could also reproduce essays, aesthetic, 
philosophical, psychological in content, which filled their readers 
with admiration and delight. _Therefore, we will not be too much 
impressed with Leopold’s ornithological or other achievements— 
even if they are to be taken seriously! 

We read further that the two boys, especially Leopold, have 
also imposed some others with “their clear juridical ability to pass 
judgment.” Above all must be emphasized the fact that judg- 
ment is simulated by pure memory knowledge, and we refer also 
to what has been said (pages 53 and 65). Here, we should like 
to ask only: Have these youths, who could dispute so ably over 
paragraphs, actually comprehended and grasped their sense? 
Would they who ought soon to free others from the bench of the 
accused have come themselves to it so early, if the paragraphs 
were not empty of meaning to them? What does it avail that 
somebody can cite paragraphs, if he is unable to digest their con- 
tent, to work them over within; if he cannot feel them and there- 
fore act in accordance with them? The morally anaesthetic also 
knows the ethical laws quite well, but he is not influenced by them. 
Even in individuals without conscience, wholly mild traits often 
still slumber at bottom. ‘They are, however, so pressed back by 
the illness that only the animal instincts come into play. 


Another question is whether arrest or a long sojourn in prison 
can bring about a psychosis. It becomes evident that lack of 
sufficient movement, nourishment, and air; further, the loss of 
freedom, the solitude that makes it possible for the prisoner to 


75 


give himself up to his own thoughts; then the anxiety for the 
future, sometimes remorse for the deed committed, often the un- 
certainty as to the carrying out of the sentence, may produce a 
powerful psychic reaction. Yet, in cases where a mental dis- 
turbance results, we have to do with a more or less pronounced 
congenital or acquired tendency. We find in such persons already 
before their arrest so many symptoms that the supposition is 
likely that the disease has been in preparation for a very long 
time. Besides, we see that people who manifest psychic symp- 
toms as a result of their arrest or other moral influences often 
already have been ill periodically; so that the arrest or the de- 
tention in prison has only caused the outbreak of more severe 
symptoms. 

The older psychiatric school assumed the existence of a specia} 
“prison psychosis.” Its characteristic symptoms were supposed 
to consist in acute outbreak of excitement with hallucinations, per- 
secutory ideas, ever-present anxiety, and suicidal impulses. Never- 
theless, later researches taught that there were here a large num- 
ber of the most diverse manifestations (hysteria, epilepsy, general 
paresis, alcoholism, and so on). And almost every one of these 
mental disturbances, so far as they break out in prison, shows a 
specific character through the so-called arrest symptoms, which 
lend it a special coloring. 

We know, besides, that the very conditions in prison are the 
decisive causes for the release of acute symptoms in the course 
of a catatonia which for a long time has existed previously in 
latent or undeveloped form. As a rule, this acute stage passes 
quickly, especially when the patient is given the suitable circum- 
stances, for example, in the prison hospital or in an asylum. 

It is well-known that prisoners simulate psychoses, though 
this happens more rarely than we think. But this point does not 
enter into the question in our case, for Leopold and Loeb would 
at the most have wanted to simulate—individuals mentally sound. 


76 


After finishing this work, there have come before the court 
some new facts which are certainly worth mentioning here. Above 
all, let me note some incidents that happened with Loeb in society. 
They harmonize completely with his nature and are so character- 
istic that every one of us would be forced by them alone to make™ 
the diagnosis of catatonia. | 

“On one occasion Loeb came in, and I am positive he had not. 
been drinking. He took very flippantly the introduction to some” 
guests he had not known, and that was not his custom. He ther 
started dancing down the middle of the room, and at that time | 
we were passing some chocolates. Loeb stuck his thumb in each 
of them, trying to find a hard center, and he did this in all serious~ 
ness. Then he went out into the reception hall and tried on all 
the guests’ hats. 

“Several times Loeb came to the house, and when he would 
leave it, he returned and handed back some ornaments he had 
taken, ‘Here, you had better keep this; your mother might need 
it. It would be something he had picked up around the. house, © 
and he seemed proud of his ability to take it without detection. 
Once we were driving in Loeb’s car, and he had the idea of trying” 
to pass all on the road to see how close he could come to them in 
dodging around them.” | 

Other witnesses stated: “In discussion Loeb would argue on 
worthless points and try to make them important, sticking to them. — 
He worked himself into childish zeal in any co-operative effort © 
and annoyed his companions. Because of his childish and irrespon- — 
sible character, he was never made a mentor in his senior year. 
Nearly all seniors are made mentors over freshmen to guide them 
and ease their way through the first year, but this privilege was 
never granted young Loeb. Nine years ago he was seen picking © 
pockets and stealing postcards. Loeb spoke in a jerky manner, 
uttering words hastily. In smoking, he consumed the whole 
cigarette in a few puffs. In walking, he would walk for a while 
and then run a while. He would ‘pop’ into a room instead of 
walking in. His movements were jerky.” * . 





*Tt cannot be stated emphatically enough that he who compares the 
symptomatology of the catatonic diseases given in modern textbooks and 
monographs with the data obtained from the previous life and the present 
condition of Leopold and Loeb will not be able to escape the impression 
that precisely such human types must have been in the minds of the 


77 


| Such signs we are accustomed to call mannerisms or peculiari- 
ties, and they have been portrayed in larger works on catatonia in 
these very words. Besides, we speak in psychiatry of a catatonic 
gait when any one alternately walks slowly and then runs quickly. 
Very typical are also the stories of the chocolates, hats, and orna- 
“ments, the kind of smoking, the jerky movements and manner 


j 


of uttering words—all statements which testify an admirable gift 
of the witnesses to observe essentials. Likewise, the bursting into 
-a room instead of walking in—at this age, of course—can be ex- 
-pected only of the catatonic. Another circumstance of greatest 
“significance, which was, however, interpreted in a very curious 
“manner, also justifies, according to what is said page 39, the diag- 
‘nosis of catatonia. During an investigation, Loeb “choked up 
and wiped his nose with his finger.’ This outflow of nasal con- 
‘tent was regarded as outflow of affect and has been taken as evi- 
dence of emotion, which, in turn, as such, was supposed to have 


added testimony to the normal psychic condition of the patient. 


; 








> 


A question that cannot be omitted in Loeb’s case relates to the 
presence of his fainting spells. The meager information does not 
permit us to determine whether the three attacks which were ob- 
served at short intervals are epileptic or epileptiform in nature. 
Nevertheless, it must be asserted that the fainting spells have 
absolutely nothing to do with the supposed drunkenness. One of 
our statistics reveals, for instance, among 2,700 catatonics, 97 
cases in which attacks were noted, even with all the characteristics 
of what is called true epilepsy. In our monographs this question 
has been discussed in special chapters and illustrated by appro: 
priate cases. We could prove that some catatonics had suffered 
during the period of teething; that attacks had appeared by day 
and night, isolated or in succession, and not only as precursors 
of catatonia or in its beginning, but for months and years after 
the outbreak of the disease. Many times fainting spells came 
during the return or in the last stage of the psychosis. We have 
also pointed out that convulsions appear in all forms of catatonia 
and at any age of the patient. Further, it became evident that 
authors when they were establishing this form of psychosis. Every 


sentence, every facial expression, every gesture and movement of the two 
boys, ears a catatonic stamp. 


78 


attacks belong to the gravest symptoms of catatonia, and special 
attention was called to the fact that, as precursors of true epileptic 
convulsions, there have often been noted fits which run more or 
less completely as hysterical or psychogenic seizures. From our 
discussions of the causes and nature of catatonia, it is clear how 
the existence of epileptic or epileptiform attacks is to be explained. 
It has been demonstrated in an irreproachable manner that the 
convulsions result merely from disturbance of the endocrine 
glands. I have shown also, through investigations in two large 
asylums here,*” *® with what frequency epileptic and epileptiform 
seizures may simulate a catatonia. 

* 


Concerning Leopold, it may be added: “While he did not think 
that Nietzsche’s superman now existed, one would come. He 
would be a law unto himself, above all men’s laws. Leopold said 
all his friends were means to an end, and when he could not use 
them he would throw them aside.” A witness for the State de- 
scribed Leopold “as a marvel and genius in his studies. His 
memory was so good that he could quote long passages after 
reading twice. He talked superman frequently. This man could 
make laws to suit himself. Leopold stated that if it gave him 
pleasure to go out and murder some one, he would do it; but, of 
course, he must not be caught. He kept saying that he would 
try anything once. With all of this, his judgment was bad and 
his reason lame. 4He did not have horse sense.” That means: 
Leopold the marvel and the genius and Leopold the man with bad 
judgment and lame reason—are these not two quite different 
persons? 

The following incident appears also of interest: “Leopold fell 
into spasms of laughter, laughter that held a mingled note of 
relief and the hysteria of excitement.* He held his mirth within 
bounds until court adjourned, when his laughter became 
uncontrollable. The tears ran down his cheeks as he laughed. 
Many thought Leopold was hysterical and weeping, but to his 
counsel he said he was laughing at the attempt to overthrow his 
doctor’s opinion.” 


* Such laughing spells we note very often in catatonics. They are com- 
pulsive in character, despite the fact that the patient afterwards tries to 
give an explanation of their cause. 


| i 


3 The objections made in the court to the x-ray findings of the 
pineal gland are valid only with regard to the interpretation of the 
pictures as such, though it is a fact that a decreased function of 
this organ—in which Descartes has formerly located the seat of 
the soul—may result in a precocious sexual maturity. But is 
‘this perchance all that the investigation ought to reveal in the 
‘case of Leopold and Loeb in the field of endocrinology, which was 
compared during the trial with darkest Africa? It can be readily 
understood that the vision of blackest Africa may so darken the 
‘mental horizon that instead of a house only the door at the side 
entrance can be seen. Is this a ground, however, for pronounc- 
‘ing a death sentence upon a positively definite part of science? 
_ That endocrinology until now has not conquered the authority 
and position it ought to have is due to the fact that the investiga- 
‘tors not always earnestly enough studied the often very compli- 
‘cated, involved processes, and that a kind of dilettanteism creeps 
‘even into the laboratories and clinics. Instead of getting at the 
‘bottom of the matter, one often loses the way in theoretical ob- 
jections which are set forth without the obligatory critical spirit. 

The real value of theoretical deductions is clear from the 
words of Claude Bernard, that great pioneer in endocrinology. 
“When you enter the workroom,” he used to say, “leave your 
theories behind you in the cloakroom with your overcoats.” But 
he would add, smiling, “You will take them with you when you 
go out.’””’ And Pasteur expressed himself thus: that “just as one 
would in the morning sweep out the workroom to free it from 
dust, so must the theories likewise, which are loaded upon our 
experience, be swept away.” 

“Science resulting from experience,” Richet said, in his paper 
offered in 1923 to the International Meeting of Physiologists in 
Edinburgh, “makes merry over classical physiology. When the 
immortal Harvey discovered the circulation of the blood, he set 
aside the classical physiology of Aristotle, Hippocrates, and Galen; 
yet, for more than twenty-five years, he had to bring upon himself 
the storm of indignation of all the professors. The theories of 
Stahl and Willis also fell when Lavoisier proved that life is a 
process of oxidation, therefore a chemical operation. Claude 
Bernard directed against himself all the physicians and the whole 
company of physiologists when he showed that the human body 


80 


can produce sugar. And with what powerful opposition did 
Pasteur have to fight when he set up his teachings concerning 
bacteria ! 

“The above-mentioned investigators were great revolutionists 
only because they did cast away opinions which had arisen from 
banal conceptions, vulgar prejudices, from theories and points of 
view originating with men obstinate, having at the best only 
routine, and not willing to content themselves with facts. Ex 
perience and ability for observation: these are the two means 
which solely and alone lead to cognition of the truth. No one 
should be satisfied with the words magister dixit; and even the 
greatest authorities can never serve for pointing out a way, in sO 
far as they will ignore the above-mentioned methods of research.” 


It would be very difficult to discuss here the psychiatric 
counter-opinions upheld during the juridical proceedings. The 
points of view and the arguments pushed from the first day into 
the foreground in judging the cases of Leopold and Loeb are such 
that, in our belief, they do not at all suffice to bring decisive testi- 


mony upon any psychic condition, especially as to mental 
soundness. 


81 


) 

| It is taken for granted that psychiatrists cannot object 
that the utilized material, as well as the picture drawn of the 
clinical condition in which the two youths find themselves, does 
not suffice for deducing definite diagnostic conclusions, and that 
I have not fully enough supported my statements with concrete 
examples. Far more do I assume that in the symptoms portrayed 
have been demonstrated a series of typical signs which exactly 
call for the diagnosis of catatonia. Besides, we ought to consider 
also those occurrences for which life itself has brought the glaring 
Boots. But what does that mean? Have we not, even in cases 
an which the disease is more evident, gained our experience first 
‘from the life of the person afflicted? Whence do we know the 
value of this or that symptom and condition? Only from prac- 
tice. After having investigated minutely, in the course of twenty- 
five years of study specially directed to this end, an immense 
number of patients who continued in a more or less totally de- 
‘mented state and in whom, since their full life records were at 
‘hand, it was possible to trace back retrospectively the disease to 
‘its first beginning, I could and was forced to establish that a cer- 
tain sort of symptoms is found in the beginning of the disease 
exclusively in such individuals who in time fall victim to a char- 
‘acteristic deterioration; while, on the other hand, symptoms 
mever have been found in them which again were distinctive for 
other diseases. Furthermore, the old psychiatrists believe also 
‘that with persons who, for example, manifest harmless delusional 
ideas a secondary dementia, as they define it, can develop. For 
‘us, however, this deterioration is not secondary, because it has its 
roots in the nature of the disease. Life’s experience has shown 
us that people with delusional ideas, even when these still exer- 
cise no influence upon their actions, yet gradually lose their 
mental freshness and alertness, as well as the vitality of their 
feelings, until finally total emotional destruction is established. 


Pathological anatomy, it is true, seems to be unable to help 
‘us in this direction. For this reason, we are not in a position, 
‘even after the death of the patient, to bring sure proofs of the 
‘disease. The post-mortem examination also, together with a 
‘microscopic investigation of the brain, permits us in no way to 
“say, “Here is a destroyed brain that could no longer function 
normally!” We may make no such exclamation, because—as is 














82 t 


emphasized in my various papers—with our methods up to the 
present time, we are unable to demonstrate constant pathological 
changes in the brain, even in typical cases of psychic disease. And 
if this could be accomplished, it would still remain to be shown 
that these changes are the causes but not, as the other clinical 
symptoms too, only results of the morbid process. Fundamental 
inquiry into the previous life and the present condition of many 
such patients is left therefore as the sole and exclusive criterion, 
for only upon this road may we draw conclusions in regard to the 
psychic abilities of a person. ' 


No one would want to explain the above-sketched picture of 
Leopold and Loeb through external circumstances. It must be 


admitted that healthy, normal youths growing up in favorable 
conditions ought to become SiREURINE-ESS in society. The sad 
result which has been brought about in the life of these two boys 


must therefore be referred back exclusively to the disrupted mental 
activity, to the intrapsychic disharmony, which, trom the io. 
"vealed also in THIS CaSe-WOUTE be GENgIRTEG Chey a8 an enor 
mous weakness of judgment due to deficiency of the apparatus that 
draws conclusions. I have used the word chiefly not to point out 
that still more symptoms are necessary to complete or fix the 
clinical picture, but in order to express that even further dis- 
turbances of the emotional equilibrium may be present, which an 
investigation specially directed to this purpose would bring to light. 

The grossest defect shown also in Leopold and Loeb’s case 
results consequently from faulty ability of j > which is 
most glaringly manifest in an impaired understanding of things 


. 


and in an inadequate observation of facts. We know, however, 


from our life practice that false conceptions, prejudices, preformed 
opinions and ideas, so far as somebody drills them into his head, 
do mot fall under the influence of his reason. At the best, we 
can expect in such cases a diminution of the emotional and in- 
tellectual energy, which, on its part, leads to the result that the 
person concerned reacts more and more rarely and less strongly 


: 
: 


83 


to external stimuli. But years may go by before this comes to 
pass; while Leopold and Loeb in this phase of their disease have 
already fallen into such a conflict with the external world and its 
institutions that society must protect itself against them as against 
insane persons who threaten the public safety. - 
Furthermore, the boys also do not possess at bottom the ca- 
pacity to understand the punishableness of their delict. There is 
lacking in them the consciousness that the basis of their entire 
activity, the presuppositions upon which their thinking is sup- 
ported, are conceived and built up in a delusional manner and an 
illusory fashion. For this reason, the mere intimation that in- 
dividuals of this sort shall submit to a psychiatric examination 
rouses—often only superficially—protest on their part. The pa- 
tient at first refuses such suggestions with derision and scorn. 
The correct grasping and understanding of a matter is, how- 
ever, the only one mark by which we can judge the social sense 
of an individual. Whoever possesses this attribute may even 
betray a certain mental weakness and because of it slip from or 
wander about in the paths of life, but every such occurrence 
forces his feeble head to reflect upon it; and finally he chooses 
a more humble way, where he will no longer stumble and no 
destruction threatens him. He enters upon it, perhaps, with a 
heavy heart and with lamentations toward his fate. But his value 
lies in the fact that he adapts himself to the present conditions, 
that he contents himself with little and limits the circle of his life. 
Upon what, now, depend this grasping and this understand- 
ing of a thing? In the first place, it is not a matter of the 
intelligence—it may be and is indeed predominently an affair of 
the emotions. Even an intelligent man may be wanting in that 
effective judgment in reference to a thing. We question further: 
On what feeling above all is that ability to look into a matter 
based? We will refrain from a long psychological discussion and 
formulate the answer thus: The ground of this understanding of 
a matter is only the moral characteristics in the widest sense of 
the word, for there is also a purely practical morality. If, there- 
fore, any one possesses moral sense which is of a low quality, but 
still he has it; then it must be a person of unusual intelligence 
and force of will who, with weak ethical qualifications, is never- 
theless to become and remain a social individual. If, on the other 


84 te 


hand, we have before us an individual of a mediocre mental level, 
the indispensable condition of his life within the community is 
eo ipso his inner social morality. It follows from this that, if we 
see in a person psychically none too highly developed and with- 
out strong will an asocial life, of which, however, he is not con- 
scious, we may draw from this the direct conclusion that his 
ethical feeling is impaired. 

We come to the question: Is this injury a congenital phenom- 
enon, or can it be acquired? In the latter case we must reckon 
with the possibility of an alteration—for the better or the worse— 
while in the former case this is already a priori excluded. 

In so far as we have not to do with an entirely undeniable 
organic brain disease, we may decide this question only when we 
have looked into the whole life of the individual concerned. 

It may be natural to find a person an enemy of society, or 
even a criminal, in so far as he has grown up in a Maffa group, 
where defiance and breaking of the law were habitual.* Yet a 
child born in stich an environment may be transformed into a 
respectable and law-abiding citizen, if educated in other conditions 
and given suitable training. In our case, however, we are con- 
fronted by a situation in which a criminal course has been entered 
upon by individuals who have arisen within the better social 
circles. We are forced, therefore, to find the cause of the mode 
of action of Leopold and Loeb not in their surroundings, but in 
the personality itself as result of a pathological mental condition. 

In any case, neither Leopold nor Loeb have possessed the in- 
sight and the ability correctly to understand a matter. This has 
been conditioned by the disease, which must lead to that character- 
istic disturbance in the performance of the psychic functions. 
The defect developed itself gradually, inasmuch as the two boys, 
with the education which has been theirs, ought not, under normal 
conditions, to be that which they are. 





* Compare page l. 


85 


Let us turn now to the problem which does interest the jurist 
and the psychiatrist alike ; namely to the question how to estimate 
the mental anomaly in the case of Leopold and Loeb. Here it 
will be best to consider separately the two standard viewpoints ; 
that means, the legal and the medical. 

In the pure psychiatric sense, we speak in analogous cases 
of a mental disease + which always represents a brain process; 
but not of a pathological condition, of an abnormal tendency, of 
psychopathy, which is in principle a congenital anomaly. 

Mental disease stands under the protection of the penal code; 
the psychopathy, however, is measured by the legislator accord- 
ing to the grade and the symptoms in which it manifests itself, 
and is to be considered in the juridical sense merely as mental 
weakness. The law assumes a mental disease also in the psy- 
chopath, but only in the quite severe cases, in which those ap- 
prehended defied all effort at training and have completely re- 
sisted the educational influences of life. 

We have already sought to explain why it would be inadmis- 


sible from somebody’s momentary behavior, even if it seems to be 


| 


mostly rational, to draw valuable conclusions with regard to the 
condition of his consciousness. ies 

We know, for instance, that in sleep walking or in hysterical, 
respectively, epileptic twilight states, where consciousness is dis- 
turbed in the highest degree, we nevertheless discover actions 


which follow a quite definite goal. From the wealth of examples 


recorded in psychiatric literature, I take a case which Légrand du 
Saulle has published. It relates to a merchant of Paris who had 
‘traveled about for a long time in such a state, until suddenly 





: 
! 


) 


| 





| 
| 
! 


he came to himself in the harbor of Bombay. ‘These people 
in the meantime behave themselves quite normally during their 
travels by land and sea. They make plans for their journeys, 


purchase tickets and other things, find out hotels, pay their bills, 
enter into conversation, share in recreations and games, and so on. 


On the other hand, the persons concerned can commit in these 


states all kinds of crimes and delicts. Sometimes such a condi- 
tion of clouding of consciousness lasts still longer.t Alzheimer *° 





+ This is identical with insanity or psychosis. 


t Having closed this work, I found in the newspapers of August 5 an 
item which is quite noteworthy, and we will cite here the chief points, even 


a 


86 


speaks of cases in which this stage continued for a year and a half; 
so that one business man knew nothing of his change of residence, 
which had occurred in the meanwhile, and another patient had no 
knowledge of the birth of her youngest child, to whom she had 
given life while in this condition, I have reported ** also a patient: 
who fell into such a state of clouded consciousness for the entire 
period of her pregnancy and the birth, so that she would not 
acknowledge the child she had borne in the interval, insisting that 
it was not her own but a “foisted’’ one. t 

Analogous cases are interesting even from the forensic point 
of view. Kraepelin describes in his textbook a patient who in 
such a state used to write to the police, accusing himself of all 
sorts of crimes. Once it was an attempt to overpower a woman; 
then again he gave himself up to trial for murder. The man had 
been condemned to imprisonment for the first delict ostensibly 
committed, and only in the course of later investigation was it 
proved that the self-accusations, including that for which he had 
been imprisoned, were the product of delusions and compulsive 
thoughts. The patient explained that there were times when he 
was not able to withstand the idea that he had been guilty of this, 
or that crime. “I feel then,” he said, “that some one stands be- 
hind me and calls, ‘You must accuse yourself now to the police!” 





if the reader afteady knows of them. 

It was told that the lost society girl, Miss A., from _Philadelphia, wha 
had been sought for five months, was found in "New York and brought 
home. The girl stepped briskly from a train at North Philadelphia in the 
company of her father, but wholly oblivious to her surroundings. As she 
reached her home she shook her head at her mother’s question, “Don’t you 
know me, Honey?” The daughter complied, with no special show of 
feeling, when her mother pleaded for a kiss of greeting. 

For a moment, however, she apparently recognized her position, 
asking her grandmother, “Why didn’t you come for me before?” When 
shown her clothing, she began to display familiarity with her surround-. 
ings. She could also remember that she struck her head on the vesti- 
bule of a Pullman car on her way from Baltimore to Philadelphia. | 

When she arrived in New York, she registered at a hotel as Miss 
Jane Johnson. Under this name she obtained the next day work at a 
newspaper office in the telephone department. She gave evidence of 
culture and education, learned quickly, and was advanced rapidly. 

When her father greeted her in the office, she said that she did not 
recognize and remember him. But she was willing to go with him to 
Philadelphia, if he was certain that he was her father, even though she 
PE know him. “What a funny little mustache you have!” she said 
to him 

Miss A. looked well but weighed about fifteen pounds less than when 
she disappeared. 


87 


At such times I am completely filled with thoughts of murder 
and crime.” 

It is evident from what has been said above that consciousness 
may be wanting even in very reasonable and premeditated ac~- 
tions. Furthermore, the Leipzig Imperial Court—that is the Su. 
preme Court of Germany—also upholds this opinion, since a 
cleverly planned escape from prison and the use of physical force 
when seized are not taken as sufficient proof of the presence ot 
consciousness (Vol, XLII, p. 45). 


* 


If we go to meet the feeling of a judge to whom it may, 
perhaps, seem strange that people—like our boys—apparently act 
correctly and yet must be interpreted as unaccountable and ir- 
responsible, we shall have to notice that in such cases it is neces~ 
sary to speak of a doubled or divided will,t inasmuch as catatonia 
rests upon a multiplication of the entire personality. These in- 
dividuals, therefore, at the most, may be free within a defined 
sphere of actions, which again, as such, are conditioned by one or 
more attributes of the character of the person involved. 

Qualities of character * receive significance and full worth only 
when we consider their relation to a certain morality. Morality 
is, so to speak, the original element which gives the suitable direc- 
tion to all our action and conduct. In the last instance, it is de- 
rived from etuidemonic egoism, which, as is well known, appears 
under a variety of forms and, in its most primitive shape, con- 
stitutes that principle upon which society rests. Morality, how- 
ever, regarded from the standpoint of natural science and psy- 
chology, is only an instinct, a feeling, an emotion, that has nothing 
at all to do with the intelligence.» Intelligence at the most may 
be a psychic gift which serves for its objectivation. This instinct 
appears in manifold variations; and in court cases, where we 
speak of moral values, the psychiatrist must investigate whether 
the kind of the given variety is high or low. The single and only 
one test in this question, however, can be solely the position in 
which the person under discussion has placed himself in regard 





tI refer here quite especially to what has been said on pages 22-24 
and 42-44, 


* Character means the kind of emotional reaction of a given person. 


88 


to the environment—the comparison of his social position with — 


esis 


: 


that which we should expect him to fill. For, doubtless, every- — 
body would agree with me in this, that only the lite and kind of — 
thinking of the individual—exclusively, his emotional nature, ~ 


which we learn to know from this life—are of real value for 
estimating his worth, but never his words! 


Now, we may come upon a morality the quality of which is | 


unusually low; that means, the person under consideration per- 
mits himself to be led solely by impulses of an egotistic nature. 
That is a. condition which we call moral idiocy. Even if such an 
individual seems to be capable of choosing among particular ac- 
tions, yet in all these actions he remains, as it were, fettered by 
iron chains through his peculiar qualities deep within him; so 
that all his deeds not only bear in themselves the stamp of abso- 
lute, inveterate egotism, but they must necessarily bear it. 


The postulate of the freedom of the will in the legal sense 
conceals in itself two factors; first, freedom in choosing the ways 
which ought to lead on toward any goal, and then, that this goal 
also shall not be morbidly conceived. The juridical conception 
of the freedom of the will demands therefore that the individual 
is always able to choose, according to the circumstances, among 
the various motives for the attainment of a certain goal; and that 
he acts herein, as also in the moment when he sets the end before 
himself, “in the name of the principle of freedom.” Hence we 
can, without difficulty, in the sense of the legislator, assume the 
presence of mental disease in cases where the goal represented 
is conceived in a delusional manner. Here, namely, the individual 
is under the power of a fixed idea, which compels him to place 
all his forces and abilities at its service; consequently, to sacrifice 
that which he considers as his own and as his entire personality. 


Just this last point shows us theoretically what experience has 
long ago taught us. Even if we were able to establish in both boys 
a more or less rich store of general, and in Leopold, of special 
knowledge, notwithstanding that our youths had at their com- 
mand a good memory and could advance in their studies; still it 
was impossible for them in this one circle, in which their erring 
emotions controlled, to direct their lives in accordance with sound 
principles. Here they went their own ways, which necessarily 
had to be asocial and directed against the community; and only 


a 


89 
force could bring them from the paths which their illness had 
dictated to them. 

To consider now briefly the cases from the practical point ot 
view, I must say that this sort of disease is always dangerous. At 
one time the patients distinguish themselves by reservedness, so 
that we can never know to what their thoughts and ideas are 
directed, and what absurdities will force themselves upon them. 
Yet we must reckon with the fact that at any moment impulsive 
actions may be carried out. Such individuals are, we would say, 
glimmering sparks in the ashes, which at any time may kindle 
a blaze. {for this reason, catatonics, especially when they give 
evidence of criminal tendencies, must remain under the strictest 
surveillance ; and as long as they show traces of affect, excitability, 
and activity, that is, until they are completely demented, they 
must be confined in locked institutions. 

It is plainly to be seen that many of these patients are dis- 
satisfied with such a solution to their problem and at the be- 
ginning still defend themselves against it with a certain energy, 
for they burden the press with their petitions or protest to the au- 
thorities and make application for revisions. In certain cases, 
they seek release in suicide. 


In every large sanitarium we find patients who wish to be 
beheaded or burned or led to the scaffold. Sometimes they suc- 
ceed in putting their wish into execution even in the asylum. 
One of my patients, who insisted that she “had sacrificed herself 
for others,” in an unguarded moment set fire to her clothing and 
died of severe burns (page 101). The most frequent cause of 
similar actions—which, moreover, are carried out in such manner 
only by catatonics—lies in hallucinations or delusions ; more rarely, 
the “voice of conscience” gives the impetus for them. Other pa- 
tients consider themselves martyrs, condemned persons, or in- 
nocent sufferers. We know also that many a heretic or reformer, 
who has mounted the scaffold with smiling countenance, and not 
a few of those medieval witches who, after the process, were 
dragged to the stake, suffered a psychosis which today we should 
have to number in the group of catatonia. 

Moreover, the psychically ill not only commit suicide, but they 
also murder. In France, for example, in the years 1904-1906, 
the insane murdered ninety-two persons, while one hundred and 


90 


twenty-two people upon whom murder was attempted, were by 
chance only seriously wounded. This report, given in Kraepelin’s 
textbook, is by no means exhaustive, for it takes into considera- 
tion merely those cases which were noted in the Parisian daily 
press. 


It is not necessary to discuss here in detail the differential 
diagnosis, especially since very important distinguishing signs 
have been repeatedly stressed. Psychopathy, which only a most 
superficial observation of our cases could consider, is a constitu- 
tional disease in which the person affected deviates from the norm 
exclusively in degree. Such an individual also has not always 
grown up to meet the demands of life, whether because he is lack- 
ing in necessary psychic power or on the grounds of his false 
judgment. Even in these people appear thoughts with a delusive 
basis; yet the latter always are in logical manner abstracted from 
some facts which the person has merely badly interpreted, and it” 
is at all times possible for us to discover in his thinking process the 
point of departure for the idea. 

» Catatonia, on the contrary, is a progressive disease which has 
as its end result the total destruction of the personality. This is 
preceded by a gradually developing defect, which is most plainly 
manifested in a diminution of the psychic initiative and of the 
emotional vividness. The delusional ideas in such patients grow 
upon a scarcely perceivable basis or quite rotten foundations; 
and they separate themselves very quickly from these grounds, 
until, in merciless fashion, they have enchained all thoughts and 
actions of the individual. 

There is only one mental disease in which we can establish 
a similar destruction of the personality with complete absence of 
critical power; namely, general paresis, that means, a form of in- 
sanity which makes the person afflicted also unaccountable for 
his actions and deeds. But this psychosis is easy to determine, 
whether on the ground of the bodily condition or through the 
biochemical examination of the blood and spinal fluid. Besides, 


91 


general paresis relatively early involves loss of memory and ca- 
pacity for orientation, which do not belong to the catatonic picture. 


We believe that we may break off here our discussion upon 
the above-considered matter and also pass over the so-called 
“moral insanity,’ which is no longer a special form of disease, 
for it represents in actuality only a symptom complex observed 
in various psychoses. Yet we wish to mention a type of mental 
illness in which our two cases could be included. Already in 
1890, Kahlbaum ** had described a form of disease under the 
name of “heboidophrenia,”’ which, as he explained, was con- 
nected with hebephrenia (that is, the catatonia of today). Kahl- 
baum considered as characteristic of this disease the fact that it 
develops “with especial frequency in childhood—and in adole- 
scence—and is distinguished by deviation from custom and moral- 
ity, by criminal tendencies and criminal acts.” Kahlbaum fur- 
ther pointed out that in general this form of insanity does not 
lead to such typical “confusion and deterioration” as usually ob- 
served in hebephrenia. Hess ?® proved later that such criminals 
actually stand close to catatonia. For Anton,** too, “the moral 
degeneracy in childhood, with its abnormal lack of the higher 
categories of feeling and loss of capacity for human sympathy, 
with its impulsiveness, its negativistic direction of the will, and 
on the other side, with the increased suggestibility”’ constituted a 
disease closely related to catatonia; while Ziehen *° has already 
identified such criminals with catatonics. 

The relationship between catatonia and criminal personalities 
has been still more exhaustively set forth by Hoffmann,** Kret- 
schmer,?7 Meggendorfer,?® Rinderknecht,®° Stelzner,** and others. 
Emphasis is given most of all to the “tendency to antisocial action 
manifested even in childhood and to the aberrations of the emo- 
tional life. Such criminals differ quite essentially from other 
morally depraved individuals in this, that with them not only the 
altruistic feelings are wanting, but also those conceptions which 
would have to do with their own welfare are likewise poor in 
affect.” 


OZ 


It is plain from the symptomatological parts of our monographs 
that among catatonics we find negative, asocial natures, untouched 
by anything we call conscience. Others are hard as steel, cold- 
blooded beyond measure, unscrupulous and heartless, “will not 
stop even at a dead body.” Furthermore, it could be proved in 
the study published in 1909 that such patients who formerly were 
diagnosed as psychopaths had disclosed themselves as catatonics. 
In later monographs there was brought much new testimony and 
in the study on the psychopathic forms of catatonia, I published 
the life histories of twenty patients, each of whom for years and 
decades had presented the picture of that which is regarded as 
psychopathy. But, despite this, all the patients mentioned became 
finally demented in typical catatonic manner. Bleuler,?® Wenger- 
Kunz,** and Van der Hoeven ?°® have likewise called attention to 
the fact that schizophrenics, that means, catatonics, may develop 
from psychopaths. 

Dickhoff *° also has found that catatonic psychoses arise from 
psychopathic peculiarities, and Risch,** too, warned against cons 
founding paranoiac persons with psychopaths.* Furthermore, 
Henneberg,*t Longard,?> Moeli,?”7. Rauminger,?® Redlich,”* 
Strauss,®* have described patients who were first considered psy- 
chopaths, but later developed all characteristics of catatonics. 


We have made an effort to recognize the psychosis from 
which Leopold and Loeb suffer and to give the reasons for our 
diagnosis. Then we have tried to show that the previous life 
and the present condition of the youths must be brought into 
harmony with our diagnosis. Following this, we have discussed 
the deed upon the ground of the clinical picture; and finally, the 
question has been treated from the point of view of the legislator, 
who, in so far as he explains an individual as irresponsible, also 
makes him unaccountable for his acts. ; 

The indispensable condition for establishing the irresponsibility 





* Risch speaks of patients with delusions, whom alienists now reckon to 
the paranoiac form of dementia praecox, that means, catatonia. 


ct 


consists, as is generally accepted, in proving the inability to under- 


stand and comprehend a deed performed. \Vhoever, therefore, 
permits himself to transgress against the law and has to be made 
responsible for t this, must understand the terms, the nature, and 


the significance of the act which he has committed. He should 
grasp the relationship of this his deed to the world about him, 
to the rights and interests of other people. Yet this is by far 
not enough! The legislator sees no resistance to the law even 
when the doer was capable of understanding the deed performed, 


but was not in a condition to direct his actions. 


Consequently, the penal code demands that a responsible per- 
son not only grasps the nature of his act, but at the same time 
shows that he can direct his action by the aid of reason; that, 
therefore, he possesses the ability to conduct himself rightly by 
his understanding. 


Whoever, on the other hand, cannot employ such mental 
powers and must be counted irresponsible, with him the delict is 
interpreted as nonexistent. 


Furthermore, an individual is not punishable if, at the time 
of the committing of the deed, he was unable to conceive the 
wrong of his act or to direct his will in accordance with his 
insight. It must be emphasized that the capacity for insight has 
to be judged only with regard to the particular culpable act. Be. 
sides, insight may be present for one delict but at the same time 
be absent for another. Yet we have not to examine whether or 
not the punishableness has been perceived but merely whether the 
psychic capacities were sufficient to make this cognition possible. 
Moreover, abolition of accountability does not involve total failure 
of mental ability, for it can be brought about through lessening 
of the same. 


Again, the law takes into account that the capacity for in- 
sight into a punishable act may be lacking in individuals under 
eighteen years of age because of still existing mental immaturity. 


Further, a causal connection between mental disease and delict 
need not be established. Consequently, according to the law, it 
is not necessary to prove that the culpable act was conditioned by 
a psychosis, but we have to show that at the time the deed was 
committed a disturbance of the mental activity has existed. In 


94 


the same manner, it is not demanded that there shall be impair. 
ment of the ability to act at all, but only in regard to the delict. 

To this may be added that, from the forensic-medical stand- 
point, we have, in my belief, to judge congenital and acquired 
psychic defects differently also when they, as actually happens, 
manifest themselves through equal qualitative and quantitative 
evidences. Congenital defects in the domain of the emotion, will, 
and thought, we should designate as mental idiocy in the legat 
sense only then when they manifest themselves in very high di- 
mensions; acquired defects, however, also then when they appear 
in lighter degrees. The former, we may say, are congenital psychic 
deformities and malformations, that means, abnormalities which 
still correspond to the original nature of the given personality; 
the catatonic defects, however, are acquired diseases and always 
in contradiction to the personality. Catatonia signifies a deviation 
from the former condition, a progressive psychosis, which in 
truth can be explained but no longer understood. Something new, 
foreign, creeps into the soul; the mode of reaction of the person 
afflicted is totally transformed, his further normal development 
inhibited ; so that the individual little by little becomes destroyed. 

When we carry this discussion over to Leopold and Loeb, we 
obtain from the analysis of their psychic aberration grounds 
enough to exclude their responsibility and their free-will control. 
For in choice of actions a struggle of motives must precede any 
decision ; and only those are able freely to direct their will whose 
actions have_a_normal-basis and show-a-normal course. 


— 


95 


It has been mentioned already that catatonics very frequently, 


‘before the illness has become manifest, reveal exceptional abilities 


and quite unusual intellectual gifts. More interesting is the cir- 
cumstance that many of them still give evidence of the most 


valuable qualities during the disease which has already lasted for 


years and decades. It happens also that patients who have re- 
mained for a long time in a state of more or less pronounced 
deterioration suddenly begin to develop a creative power, and 
with it betray characteristics worthy of high-souled intellectual 
potentates. As an illustration of what has been said, I will re- 
produce in his own words an article which Dr. Adolf Heilborn 
published in August, 1912, in the Vossische Zeitung under the title 
“Intellectual Life and Emotional Death,’ adding some new ab- 
stracts of cases, and paragraphs printed in other type. 


* 


From earliest times poets have been tempted to paint in one 
or another of their works abnormal conditions of the soul. Every 
enigmatic disorder of the mind, the mystery of such disturbances 
in thought and feeling, in will and action, which make people of 
lower culture look upon persons mentally ill as inviolable or 
possessed of divinity, or even as saints, have at all times attracted 
the poet’s fancy and offered grateful problems for his genius. It 
is remarkable with what telling effect poets often picture such 
soul conditions and mental ills in their manifestation, and how 
they describe the course of their development. Possibly it is the 
result of the naive gift of observation combined with the power 
of divination that exists in every true poet; sometimes it is the 
result of his own similar sufferings—the psychic epileptic “Raskol- 
nikow” in the great novel Crime and Punishment is a classic 
example, for the author, Dostojewski, was himself a victim of 
epilepsy. Less frequently was there an analysis of the psyche 
according to scientific knowledge. If we can speak at all of 
psychiatric science in those early days, then, for instance, Shakes- 
peare was familiar with it.* 

If the literature of our time has finally become more exact 
in the delineation of the diseases of the soul, if the portrayal of 





* H. Laehr: The Portrayal of Diseased Mental Conditions in the Plays 
of Shakespeare. 


96 


abnormal mental conditions more nearly approximates reality; 
it is because psychiatry has recently furnished rich material in 
a number of popular works, such as those of Krafft-Ebing, Moe- 
bius, Forel, and Moll. These scientists have given us serviceable 
methods for soul analysis, so that even the layman no longer fails 
to understand the peculiar statements and puzzling actions of a 
diseased mind. The information spread by such works has re- 
placed the evil curiosity that comparatively recently caused many 
people to regard the ravings of insane asylums as their Sunday 
treat, with a respectful sympathy for those so sorely wounded in 
life’s struggle. 

There has recently been added to these meritorious works a 
new monograph by Maurice Urstein, the well-known Polish 
psychiatrist. The book is an exhaustive study upon Catatonia; 
that means, mental diseases tending to deterioration. This strictly 
scientific work is of the greatest significance, and no prophetic 
gift is necessary to foretell that it will immediately win for itself 
one of the foremost places in scientific, psychiatric literature. But 
it can count on an interest far beyond the narrow circle of special- 
ists as it presents a picture, clear and well-defined, of the common- 
est mental disease. The author proves irrefutably—through ma- 
terial that admits of no argument—that many cases of mental 
disturbance, until now considered curable and not leading to 
deterioration, nevertheless end in a prolonged siege of insanity and 
in a breakdown of the entire personality. 


It would be to the purpose first to outline the nature of this 
mental disturbance. Under the name “catatonia” or “insanity 
with tension,” as well as “‘premature deterioration” or “dementia 
praecox,”” we understand a peculiar combination of mental and 
later of bodily disturbances, which, after years and even decades 
of free intervals, lead to a characteristic form of deterioration. 
At first the victim gives evidence of a complete change of per- 
sonality. We are concerned with an intrapsychic disharmony, an 
inner laceration, a division and a doubling or multiplication of 
the psyche, together with a full understanding of all that takes 
place around the patient. The bands of association are broken; 
thoughts slip out of their regular grooves. Consciousness breaks 
into fragments, the ingenious machinery of the brain—if we may 


97 


so express it—into its component parts, each of which tries to 
work for itself with no regard for the coherence of the whole. 

Numerous patients outlined this condition with extraordinary 
clarity in the following abstracts :* 

All actions of the catatonic show the lack of a definite aim, 
the failure of logical conclusion. ‘This loss of mind harmony, 
that is, of unity and coherence of psychic function, leads to the 
wildest imaginings, to the most striking contradictions in the 
nature of the patient, above all, to a lack of affect and appropriate 
emphasis of emotion. At the same time, strange to say, perception 
and memory remain normal; while, on the other hand, the power 
of judgment is soon lost, going down hill rapidly and severely. 
Of a much rarer occurrence is it that sometimes a seemingly long- 
lost mind is suddenly restored, so that the dull patient again finds 
himself in full possession of all his faculties. 

Among the numerous examples with which the author proves 
this, none is more startling than the creative copying of the Ten 
Commandments in French, by a patient who had been unin. 
terruptedly ill for a period of sixteen years and was almost totally 
deteriorated. In the midst of a disconnected letter to her sister 
the patient writes: “Perhaps you will be glad to know that in my 
solitude I have discovered how we can dress ourselves equally 
well and not too expensively. If you will make me happy on my 
birthday, please send me some yarn. You know that I enjoy 
religious questions, and so I will let you know how I have trans- 
lated the first three Commandments. 


Les lois de Dieu, 
Ordre premier. 
Je suis le Maitre 
Il faut me connaitre, 
Ordre second. 
Le nom de Dieu est sérieux 
Comment? 
Pour avoir de Dieu 
une bonne préférence 
Nous devons craindre 





* To avoid repetition, we refer here to the indeed classical sentences 
offered by our patients (pages 21-24). Dr. H. has cited them after the 
original text. 


98 


aimer et avoir confiance. 

Ne pas faire malédiction, 
non jurer, 
Non mentir 
Non enchanter, 

Mais prier, louer, sentir. 
Etre gracieux. 
Ordre troisiéme. 

Tu dois faire dimanche 
Comment ? 

Nous devons craindre 
Et aimer Dieu. 

La préche non mépriser. 
Moise entendre 
Et apprendre 


From another mostly quite confused letter we cite: “God is 
love. A clergyman said, ‘When I come to this part of the Holy 
Scriptures, I would most gladly close the book; so rich in content 
is this sentence that the thoughts seek for room.’ Dieu est l’amour, 
Un prédicateur disait, ‘Quand je viens a ce mot, je fermerai le 
livre, tant il y a a penser et a exécuter.’ 


Ici est l’endroit 
Voila de Dieu les lois. 

Quand tu n’as pas, en trop, de miel 
Ici est l’entrée du ciel 
Ici demeure justice, 
On aime les sacrifices 
Regardez les rayons, 

Il n’y a pas de plus beaux chancgons 
Jérusalem, beauté, 
Je sais comme tu es glorieux, 
Tu as de lumiere 
Pour le jour entier 


In the analysis of the case the author says: “The patient, who 
for the most part remains dumb and does not even speak to her 
sister when she visits her, often giving a silly chuckle, who keeps 


99 


her cakes in the bedpan while she eats her excrements from a 
plate, is at times inordinately violent, ill-tempered, impulsive, ag- 
gressive, resistant, and in her personal habits extremely unclean; 
yet even in this condition, she writes a number of poems that show 
independent thought. Her verses are in no wise a mechanical 
labor, but confront us with a creative talent that is in sharp con- 
trast with the patient’s condition and her confused letters. She 
does not translate; she furnishes something new, at times, in a 
foreign language. She does not give words only, but the meaning, 
and this in a highly polished manner. In the Commandments 
created by this patient, there is something so strong, so significant, 
and one might be tempted to say, so gripping, that a Bossuet or a 
Massillon would not be ashamed to claim the writing as his own. 
And yet it is the creation of a deteriorated mind. Let us state 
here that the patient has not borrowed any one’s translation. This 
was verified for me by several clergymen, among them French 
ones. Notwithstanding the fact that a catatonic, even in the ter- 
minal state of the psychosis, can manifest a phenomenal memory, 
it seems out of the question that the Commandments had been 
memorized when the patient was well.” 


Such an awakening from the night of the mind generally lasts 
but a moment. The patient finally becomes dull, goes to pieces, 
loses interest, may do nothing of his own, cannot pull himself 
together, is without will power and action; presenting a picture 
of a being whose sense is closed, and whose heart is dead. A 
premature death of the soul characterizes just the catatonic. 


Naturally, this picture is not the same in the details of the 
development of each case. The intellect, the general culture, and, 
not least, the milieu from which the patient comes, and in which 
he was forced to live, are of greatest significance for the single 
features. It is self-evident that in the case of a genial catatonic 
like Schumann * the lines in this dread picture will not be drawn 
so coarsely as in that of a farm hand or a servant girl. Of course, 
even intellectual leaders become deteriorated. They also die for 
the outer world or at least for their own social circle, in which 
little peculiarities are noted more quickly and make them difficult 
to get along with. In general, however, we cannot expect to 





* According to Moebius. 


100 


find, even in the advanced stages of the psychosis, the same p:cture 
with which we are familiar in patients of state or community 
institutions. 


We may interpolate here that the famous poets, Hebbel, Scheffel, 
Hoelderlin, and Gutzkow also suffered from catatonia. Among musicians, 
Donizetti, as well as Schumann, had the same illness. The sculptors and 
painters have had but little attention paid them by pathographs, foremost 
among whom is Moebius. We are only familiar with the article about the 
Belgian painter Wiertz and with Courbon’s study: Etude psychiatrique 
sur Benvenuto Cellini, whose morbid teachings are said to have influenced 
the two Chicago boys, especially Leopold. Kraepelin is justified in his 
assertion that every important prize competition has submitted to it sketches 
and drawings which forcibly remind one of the productions of catatonics. 
Very instructive is also Prinzhorn’s recently published monograph, The 
Plastic Art of the Insane. Quite remarkable pieces of sculpture made by 
catatonics are found in the well-known Villa Palagonia near Palermo, which 
has been described by Goethe. 


As I have said, I consider the author’s proofs of his correct 
judgment of symptoms, nature, development, and termination ot 
catatonia irrefutable. They are so because he shows us the entire 
life course—and sometimes the observation of the cases runs back 
through fifty years—disclosed in a diary penetratingly analyzed 
from the viewpoint of a psychiatrist and psychologist. Besides— 
this seems to me the most valuable part for the public as well as 
for the writers and novelists—through a rich supply of material 
in letters, stenographically recorded conversations, reports of pa- 
tients regarding their own condition—in short, through such ob- 
jective “human documents,” the author gives us glimpses of the 
soul life of these sufferers; and he pictures to us the mind’s dark- 
ness in a manner that could be furnished by no presentation of a 
mere observer, even if he were the deepest soul investigator and 
most imaginative of poets. “And these documents come from 
people of the best society, who, as a result of their education and 
intelligence, give correct information in regard to their misconcep- 
tions, inclinations, impulses, or their abnormal condition of mind, 
and can mirror clearly in speech or writing their inner struggles. 
On the other hand, through just such patients, we can easily make 
a study of the gradual let-down of all psychic functions, being 
able to show the resulting defects, the decline of each function 
of the mind, the loss of the former healthy personality, the frag. 
ments remaining, as well as the gradual sinking on the social 





101 


ladder, which, as several reviews prove, may happen twenty or 
thirty years after the onset of the disease.” 


We quote several of the moving human documents, as this 
will show far better than any critical commendation the real value 
of the author’s work. 

“T should like to make you happy with good news,” a patient 
who has entered the institution for the third time writes her 
husband, “but £ regret I cannot. Now I believe I shall never be 
well. This time it is entirely different from formerly. What 
‘might happen! I should so like to speak to you—possibly that 
may help me. If only something would come from all my suf- 
fering, if it could help some one, if I could help you all with it, 
lien would I gladly bear it; but this frightful torture—to know 
that I am gradually losing my reason for no purpose, but on the 
contrary so terrible for you: that is, I might almost say, enough 
to make me become insane. My poor, dear Ernst, you must ac- 
‘custom yourself to the thought that I shall not improve, at least 
not to the extent that as a rational human being I can still live 
among rational people. Even if my intellect stands still, you all 
must live on; even if I am unhappy and insane, you ought not to 
suffer by it. Some one must keep house and look after the chil- 
dren. If I could only get well, Ernst! I constantly beseech God 
that for your sake he should heal me. I have become pious, yes, 
because I see that human beings, in spite of love, faith, sacrifice, 
cannot help me. What will become of the children? If God does 
‘not protect them, no human care and solicitude can.” After four- 
teen years of very grave psychosis, this highly deteriorated patient, 
‘at a moment when she was not guarded, set fire to her clothes 
and next day succumbed to her burns. 

Another patient * was conspicuous for her mental capabilities 
and a self-culture far beyond that of a country girl. With no 
music lessons, she played piano, violin, guitar, and zither. She 
prepared herself by reading for a relatively general knowledge and 
a thoroughly correct written power of expression. Besides, she 
never neglected her household duties in any way. In the course of 
time we have from her an important collection of poems and 
songs, principally of elegiac content. The subjects of parting and 





* Case 1 in paper.’ 


102 


being forsaken, of lost happiness, unfortunate love and withered 
hopes seem specially to attract her. About six months ago, symp- 
toms of a psychic disturbance were clearly evident, and these in- 
creased as her fiancé, after convincing himself that she was 
abnormal, broke their engagement. Intent on suicide, that patient 
jumped out of a window; but the result was only some broken 
bones. She was then confined in an institution, and after about 
two months there, she wrote: 

“Ja, bittrer noch und schwerer als selbst des Todes Pein 

Ist lieben—und vergessen von dem Geliebten sein.” 
(Yes, even bitterer and harder to endure than death 
Is to be in love—and to be forgotten by one’s love.) 

Dear Anton! Forgive me if, in following a warm impulse of my 
heart, I address you in this way, even though I received no answer 
to my letter and fear that this will be returned to me unread. TI 
do not desire to wrest your love, since it seems this has been 
killed for me. Human prejudices, envy, and hate have estranged 
your heart. Some one has given you a picture of me and my 
family that will make it easy for you—to forget. Lisette H. gave 
you full details and called attention to facts that you could not 
easily overlook. Furthermore, Lisette informed me long ago that 
your parents would not give their consent, and that I only wished 
to force myself upon you. | 

I put to you the question, “Do you believe that I no longer 
enjoy a healthy mind?—only because your brother had sent me 
word that he also heard such gossip. I wished only to ask you if 
this troubled you in any way. You believe you see in me a hard, 
cold-blooded, calculating being; how painful it is for me to have 
you think this of me! How good it would be if I had a heart of 
stone, over which everything might slip without impression! How 
much lighter my burden would be! I could then look at the world 
with happier eyes. Instead—what do I see before me? An 
existence of quiet resignation. My happiness, my peace is gone. 
“Only tears the short Spring gave me.” I have but one consoler— 
my dear, true friend, “Madame Musika.”’ To her I swiftly turn, 
complain, cry out on her breast: she shares my pain, every tone 
weeps with me. 

Denn nur Musik laesst des Herzens Saiten vol] und rein 

erklingen, 


103 


Und mit tiefem Beben fuehlt man, wie hehre Maechte uns 
bezwingen ! 

(Only music lets the heart strings ring out full and clear, 

And with deepest trembling does one feel how holy powers 

master us. ) 

I have but one request to make of you: Be a friend to me; do 

‘not part from me in anger! 





If it is decreed that you may no longer be mine, I can be 
more content in the knowledge that you remember me in friend- 
‘ship. I can renounce, if necessary—but forget, never! Love 
is a flower that does not die, even if light and air are taken away. 
‘She droops her head and her leaves fade, but a heavenly, eternal 
sprouting reigns in her. May I hope for the fulfillment of my 
plea, and will you send me a few lines? Oh, do quiet me with 
fone word, that you will be a friend to me. Possibly after such 
Jong, long days of sorrow, I may be permitted to see you again, 
and I should be happy if I could then hold out my hand in 
: greeting to you.” In time, this patient developed deterioration to 
the highest degree, and in her last fifteen years showed the picture 
of a catatonic condition at its close. 








Another girl “was orderly, diligent, proud, sensible, and loved 
for her charming disposition. Head of her class in school. Very 
logical in her thinking but a bit precocious. Took everything 
seriously. Often a bit pedantic. If everything was not just as 
her sense of order and highly developed sense of beauty would 
Tike to have it, she could be moved in an unpleasant way and 
would even cry. In her fourteenth year, the little one often 
looked perplexed and could not reply correctly. She complained 
that people excited her, and that she could be pleasant only by 
trying with all her might. In her fifteenth year, she developed 
hhypochondriac ideas and became slightly depressed. After a con- 
‘sultation, with which she was not satisfied because the doctor 
declared her imagined stomach troubles curable, she went home, 
asked the maid for some cleaning compound with which to polish 
her purse, and locked herself in her room. When she was missed, 
the door was broken open, and the child found seated in a chair 
in the middle of the room, like a corpse, surrounded by a pool 
of blood. With a razor, she had gashed her throat and her left 
forearm, sawing through pulse, nerves, tendons. In the wounds 





104 


she had smeared the cleaning polish, which contained vitriol. 
Just before the act, she had written the following note (the hand- 
writing shows no excitement) and posted it on the wall with a pin: 


“Forgive my resolve: I could not act otherwise. Farewell, 
farewell, my dear, good, loving mother, to whom I must give so 
much sorrow & heartache; farewell, Father, Grandmother, Aunt, 
& Brother Karl. 


‘I beg of you to keep me in silent memory. Let them make 
an autopsy to discover what is the cause of my illness. I believe 
that I have won the wager, alas, to my sorrow! But I leave you 
in a world where the wounds of the soul can be cured by time. 

“I leave Karl all my cash. Again farewell—now I am giv- 
ing up.” : 

About three weeks after the attempt at suicide, the little girl 
says: “I can’t understand how I could do such a thing. I don’t 
believe I could do it again. But I felt no pain at all.” 


During her examination by a psychiatrist, the patient said: 
“Long before the act, I noticed that I was abnormal and not like 
other children. When some one told a joke I couldn’t laugh, be- 
cause I had the feeling that this was the time I ought to laugh. 
When I thought that I wished to go to sleep, I couldn’t do it. 
When I was called on in school, I became so excited that my feet 
grew cold. If I saw an acquaintance approach me in the street, 
I grew very excited and couldn’t calm down until we had greeted 
each other. Eight days before the act, I had resolved to do it, 
I didn’t tell my parents, as they would have tried to prevent it. 
(While she was telling this she burst into tears.) At first, I 
wished to drown myself. I also thought of hanging myself. But 
how to get a rope? Maybe, so I thought, I can pay somebody to 
help me. At first, I felt sorry for my parents and my grand- 
mother, later only for my mother, and finally for no one at all.” 

During the first months of her stay in the institution, the father 
reports: “The letters of our child give us great pleasure through 
the awakened feeling and freshness of life we find in them.” The 
fifteen-year-old girl takes a lively interest in other cases, con- 
trolling their complaints through her own sensations. She would 
like to be a man, so she could be a physician. She says she cannot 
weep any more, even on her birthday, and that is a sign of lack of 


105 


feeling. When she came she could still cry, and this relieved her 
emotions. 4 

“You surely must have been worried about the contents of my 
last letter. I hope you haven’t taken it as black as it is pictured. 
We can always consider a written statement in two ways—either 
by putting ourselves in the place of another, or again from our own 


point of view . . . Yes, it is true, one becomes more and 
more estranged from oneself, since this eternal illness has come 
disturbingly between me and you. . ... I heard recently that 


God, the arch power of all being, is always immersed in intro- 
spection; that is, he regards himself with endless satisfaction, 
the Immutable, the All-wise, the Immortal! Do not place your 
faith in human beings as they are finite as the dust upon the 
earth. . . . But eternal happiness must be really wonderful, 
if we did not have to imagine ourselves with no ears to hear 
and no eyes to see.” 

In a later letter we read: “But I would agree to everything, 
if the Professor were not so great an egotist and would permit 
a few lessons from a teacher in music or drawing, or French or 
English. Every ladder to perfection is taken from me, and 
nothing is done for me. Will you desire this, dear Father; can 
you desire it? Should I proceed along the path of ignorance and 
imperfection? Speak; will you be so cruel towards your child? 
I wander in night and darkness, and I would praise him who 
would open for me the portals of truth and knowledge. He 
would be my savior. Hope soon to ride to Berlin with Karl; 
then we can visit together the Art and National Galleries. How 
astounded I was to learn from a lady here that there are original 
Rubens in our Museum. Original Rubens in our city—and for 
me, who was born there, never to have heard of it! Wonderful, 
well-nigh impossible! But how does this happen, is a question 
I put to you. How is this? Have we not so great an apprecia- 
tion for the things close at hand? Whether you knew something 
about their being there or not, I advise you, dear little Father, to 
visit the Museum and look at the pictures. They say the most 
important ones are at Cassel. Now goodbye, dear Father; I must 
still chat a bit with Mother. . . . The last time we read 
Julius Caesar; next time As You Like It by Shakespeare. I am 
very fond of Shakespeare, and yet I must say that much suffers by 





106 


translation and does not find full expression through the cut or 
catchword. This would be different in the original of these 
tragedies and comedies. I find that Julius Caesar has not any- 
thing like the effect on me that the play really ought to have, 
and that I could feel it only if I could see it in a theater. . . . 
To see Michael Angelo in his colossal greatness would be glorious. 
There is only one drawback to all these lovely, wonderful plans: 
the professor. He stands like a trick of fate between me and 
my plans, as well as my hopes, and brings to naught everything 
a god could give me to enjoy: art, beautiful, classic art. Oh, it 
is heartrending, crying to heaven! But this isn’t enough. Just 
the idea of destroying my hands through daily needlework and 
seeing them broaden like those of a woman of the proletariat 
makes me wild. How my brother is to be envied! On how many 
things he can exercise his taste! I have only people, and be- 
sides, I fear I may bore those whom I admire. Many here 
show such unbearable faces that I should like to blame God and 
the world for having created such caricatures. One tires more 
quickly of seeing faces than from looking at nature.” | 

In another quite common-place letter we read: “When 1 
think how many persons are favored by God, and how many 
others are followed only by misfortune; when I picture what 
happiness some have, and in what frightful agony others go to 
their end; then it is a redeeming and refreshing thought to con- 
sider the world hereafter and to think there will be a rich reward 
for the suffering endured here. But then arises in me a doubt, 
and the philosophical side of me demands its tribute, saying that 
our life ends with the close of our physical existence. I lead here 
a shadow life. One walks up and down just as in the dead city 
of Pompeii. Nothing moves me; nature is void and empty; and. 
I wish to God that I were able to endure this stale life and let 
no temptation come near me.* Please, dear little Mother, send 
me some of the olive-green wool for the stockings of that color— 
and the superintendent thinks I need another dress and suggests 
it be of some spring material. I’ll leave it entirely to you. if i 





* The intrapsychic disharmony manifests itself here in a splendid man- , 
ner in the transition from very sensitive and thoughtful reflections to the 
trivial demands. Such contrasts we find in early ones of her letters—in 
those of other patients, too—and from these signs alone we can mostly 
deduce the correct diagnosis. 


107 


need it at this time. I am sorry to trouble you. . . . Today 
I come only with complaints, and merely justifiable ones. I write 
at this moment to remind you that I have been here four years. 
Do please take me away from here. I’m going to pieces here, 
morally. Help me out of my trouble, and I shall be indebted to 
you all of my life. Your grateful Marie.” 


In the last writing of this patient we find: “Black melancholy, 
do you know it, dear little Mother? I believe I possess it. No 
trace of humor, no vein for joking—so equipped, how can I go 
on in this world? . . . Mind darkness is by no means so 
bad as mental insufficiency; and if ever there is justice, I hope 
to find it in heaven—here on earth there is none. On my fore- 
head seems to be written, “You are a suicide’; and people flee 
from me, as well as I from them, because the murderer is followed 


'and attacked by furies until he succumbs. I hope to see you 


again in heaven. Adieu.” 


After a four year’s stay, the patient, who was impelled to 
rack her brains about her diseased sensations and spoke much 
of Schopenhauer, was committed to a state institution. Her con- 
dition grew worse, and a complete dissolution of the personality 
followed shortly thereafter with frightful rapidity. 

In the first days after her admission the patient praises the 
high and noble spirit that prevails in L’s sanitarium. Everything 
would be different there, but especially the people finer. Yet 
quiet; accustoms herself with astonishing rapidity to the changed 
conditions of life. Plays the piano, though without feeling and 
understanding; strikes false notes, does not keep time. Stull, 
considers it, and likewise her much worse singing, as an unusually 
artistic performance. Very noticeable are also the indifference 
and lack of emotion with which the patient, having had leave of 
absence, presents herself again at the asylum. Occupies herself 
mostly with needlework and literature. Considers herself a 
philosopher and looks down upon her fellow patients with a lofty 
pride. Shows great preference for poetry, chiefly the tearful, 
sentimental sort. Begins of late to paint under direction. 


IX. Received from a patient, because of vulgar speech, a 
few blows on the ear, which she takes quietly. 


XII. Insolently pretentious toward other patients, the doctors, 


108 


the personnel. She is highly intelligent, highly interesting, and 
the like. | 


June 1887. Seizes 30 grams of tincture of iodine and drinks 
it. No regret. It would be better to let her die. Philosophizedl 


a a 


OR. 


a.) 


over her condition. She has always been the fifth wheel in the 
wagon. What should she do in the world? “What is death and- 
what life? There is indeed no God! I wanted to bring about 
a crisis.” 

VII. Fresh attempt at suicide. To everything said to her’ 
only the same refrain: “I must put an end to myself. I cannot 
live; I have no joy in anything. I am possessed by the devil, who” 
drives me all the time to wickedness, to destruction, and other) 
harm. If I want to do anything good, I cannot carry it out but 
must do evil in its stead.” | 

1888. Very vivid auditory hallucinations and persecutory 
ideas. Frequently laughs to herself. Often depressed; makes_ 
attempts to poison herself. Very much pleased at her Christmas” 
gifts. | 
1889. Taunts the other patients. Frightfully greedy. Takes 
food also from the others and gulps it down. Often has to be 
isolated. | 

1890. Excited, aggressive ; tears everything to pieces. Copies 
the other patients fairly cleverly. 

1891. Develops monstrous and perverted sexual ideas. Directs 
her wishes to a soldier, a servant, a doctor, or even her father. 
“Every girl has to have such experiences or her brain will rot.” 
Tells this also to her parents. 

1892. Does handwork and reads. Swallows everything 
which she can get. Christmas, apathetic, indifferent, without in-— 
Terese, 

1893-1900. Excessively corpulent. Quite feebleminded. Does 
not answer questions. 

1901. Lives in her monstrous ideas and grotesque delusions, 
which she produces afresh day by day. Believes herself starving, 
while she eats in enormous quantities. Often noisy, and aggres-. 
sive, laughs without motive. ; 

1902. Typical apathetic dementia. Laughs as she is in- 
formed of the death of her father. “He had always had good 
things to eat and drink; he could die peacefully.”” Also, when her 


109 


mother passed away soon afterwards, quite apathetic. Observes, 
nevertheless, her entire surroundings and makes correct remarks 
about them. ‘Talks to herself almost all the time. 

1905. Stiff and manneristic postures and movements. Fre- 
quently excited, abusive, produces only word salad. 

1910. Totally confused, dull, completely demented. Gives 
no answers. Inactive and motionless in bed. Periodically she is 
slightly excited. 

Deepest pathos is shown in a will—written on a concert pro- 
gram—and in letters produced by an older patient, of whom the 
record says: ““A hearty, cordial nature; concentrated her whole 
being on her mental life. She worked constantly with untiring 
zeal and eagerness to develop her intellect and concentrated her 
whole being only on the ideals of life. She liked nothing better 
than to be with sympathetic, intelligent people, but was reserved 
and did not unbosom herself to every one. Merry and joyous, 
especially in circles where she considered herself understood. 
Adopted a child, which she worshiped. Seven years ago, the 
patient lived through a melancholy period similar to her present 
one. For the past three months there has been a state of depres- 
sion and self-reproach, together with such strong attacks of 
despondency that she had to be placed in a sanitarium.” After 
a few weeks, she writes her husband letters, which we reproduce 
in abstracts: 


“You'll not believe it again—but it’s written here in large 
letters at every turn. Such an abyss, in which I fear to look! 
But you must act: my hands and feet are tied. The ground 
totters before my feet. If I go on in this way, it will become 
worse daily. As I already realize—a blot on human society! 
And I have no excuse! You would learn here at once that 
this is really the case. Therefore, be man enough to do from a 
distance the only thing possible to make it easier for me. If 
this does not happen, I'll do what I can. If I put it off, the 
crime grows greater with each day. There must be an end to 
it, once for all. Burn this letter at once, so that Dr. B. is not 
involved! Heistoo good! Iwishanend!onlyanend! .. , 
My shameful deed grows greater with every moment. It is all 
to no purpose. You must do as I say. I am writing contrary 
to the wish of Dr. B., but I do not want to abuse his kindness 


110 


any further. How can I write all this! If there were any pos- 
sible chance of escape—but I am fast ensnared by my deed! 
What ought you to do? I would do it myself, if you'll only — 
show me the way. . . . But every power of resolve is lack- — 
ing in me. This letter must decide my fate. As I do not know 
how to confess the fault, I beg of you to do it for me. An im- 
postor like me must be exposed. I did not believe it would 

come to this. Hedwig.” i 


After a few days the patient writes: “No running away will 
help. You must hand me over to the courts as a criminal. Miss © 
R. has all the threads in her hands and is only waiting for the 
proper moment! How I arrived at the mad action to trample © 
love and honor under foot, I do not know. If I could only 
perish by myself; but I can’t think about all the misery I have 
caused. Fraud and lies, about which they hear, strongly accuse © 
me, and which quietly I have accepted and still accept—this is the 
accusation. I have shown through my attitude that it is the 
truth. I am worse than the greatest criminal! I have played — 
with the holiest of blessings: I cannot return. The whole house 
here will rise up and accuse me of having pretended to be an 
invalid. And I have borne their contempt with the greatest 
indifference. No denial can help; no defender can save me. 
Wherever we should take refuge, the accuser would rise against — 
us. What will happen to me? How can you make up your mind 
to this? I played the hypocrite here more and more, until Dr. B. 
brought me to my senses. Of what all shall I accuse myself? 
Can one get over lies and deceit? And I can find no means to 
put an end to my life! Haven’t even the courage for this! Now 
the facts speak louder than my words. A more abandoned crea- 
ture than I does not exist. No one at my side to help me. One 
day after another passes in this way; no way out wherever I 
look. A traitor to love, honor, friendship, loyalty, surrenders 
herself to justice. Better so than to delay! Nothing like this 
has ever happened before. Each one else had long since killed 
himself—there is no other way. Must I address my plea also 
to the prosecutor? If I don’t do it, somebody else will! Believe 
me, if any one came and only once reproached me for my guilt, 
IT would affirm it.” 

After a six weeks’ stay in the sanitarium, the patient was 


| 


111 


transferred to a guarded institution. For two years she ex- 
pressed her complaints and ideas only by word of mouth; then 
she began to write letters, from which we quote the following: 


“What has happened to me is so inhumanly cruel that it can- 
not be expressed in any language. I ama cursed one, an outcast, 
one who has been found guilty. The words have lost all sound 
for me; I say them over to myself from morn till night. Ernst, 
I have forsaken you, betrayed, lied to you, and deceived you: 
I was not ill when I left you and went to the sanitarium. I no 
longer knew what I wished in life, so I wished merely to flee 
from life and represent myself during my whole life as insane. 
And, in the first hour at the sanitarium, I wished to return to 
you but could find no way back. As soon as Karl (brother) left 
me, I saw the cruel hate of the people about me, and everything 
called out to me: ‘You are cursed for time and eternity. You are 
more devilish than the devil, more hellish than hell, more brutal 
than the brute.’ And the veil was torn from my eyes: I looked 
into my life, and suddenly everything was clear to me, and I saw 
my whole life had been a lie. Each word you heard from me 
and the physicians is fraud. And so you all go to your end and 
have no suspicion; you are only cursed pariahs, ghosts among 
human beings. 


“When they brought me here I knew I was perfectly well. I 
knew I had murdered all of you, and I did not feel it. I knew 
I had turned you into a scoundrel; that it were better for you if 
you were tied by the feet and dragged through the streets rather 
than perish as the most disgraced, despised, and dishonored man 
on earth. . . . What do. they know about me? [I'll tell you! 
All of them know it, all of them, your friends, your servants, the 
air you breathe knows it. There lived a woman who was choked 
by laziness, idleness, insane confusion, looseness, and reprobate- 
ness, an idiot that had St. Vitus’s dance and carried the pest, 
leprosy; more degenerate, more inhuman, and more wicked than 
all murderers, criminals; more infamous, more immoral, more 
careless, and more ruthless than any hussy. I am the monster 
of mankind, the progeny of hell. Each word I spoke, all I did, 
everything you saw me do, was a lie. And now I have betrayed 
myself and have myself torn the mask from me. I have no soul, 
cannot feel or perceive. And when all the refuse of the refuse 


‘s 


112 


of mankind comes, it can find forgiveness: for me and through 


e 


a 


me for all of you, there is but one word; namely, you are accursed, ~ 
you are cast out from the domain of man. I went quietly, healthy, — 


and fully conscious of my hellish deed into the insane asylum, — 
because I could not take my life. And I know full well that I” 


‘ 
i 


can never live again. The damned ones in hell have despair; I ~ 
have the craziest peace. I did not feel all the countless proofs of ~ 


your true love. I could eat the cake and the ice cream you sent! 
me, and still I envied the murderer in the penitentiary who still © 
retains within himself a remnant of humanity. Here I am in my © 


< 


prison cell, and they will not let you come to me because I am © 


entirely well. I would kiss their hands and feet if they would — 
bind my hands and feet and stand me in the pillory and would © 


tear out what they know of me; if they would burn me alive, if 


they would execute me. Because I am burned, I am executed. 


Emma’s wedding has become a funeral. Our generation must — 


be erased from the earth because I, a crazy creature, have lived. — 


Kill yourselves; kill your children. Only destruction. No God 


can ever help; I can say no more until my death; only away from ~ 
existence, away from life. Chimborazo is a grain of sand, the © 


sea a drop, eternity a minute in the horrible labyrinth of my life. 
The whole city knows it: tell L. he should kill himself and his 
children, Hedwig.” 


Moreover, as she wrote her letters the patient, like many others, showed 
no outward signs of her inner unrest and agitation of mind; so that no one 
would suspect that she lived inwardly during a period through a world of 
the most terrible sensations; that the “crazy, cold quiet” she speaks of was 
lacerating her soul in so elementary a manner. When we see the individuals 
who appear in our eyes entirely indifferent, hardened, emotionless, dull, 
and then read their written productions, we can scarcely believe that they 
are the same persons who have delivered these letters. But just in this 
wide contrast that manifests itself in elementary inner affect and the in- 
ability to render it perceptible, in the striking difference between verbal and 
written utterance, we had already in our first study noted a typical 
sign of catatonia. It is entirely on account of these intrapsychic dis- 
harmonies that we could recognize at the very onset of the illness the 
ominous foundation of the disease, being able to foretell its sad end. 


About a year later the patient begs for a quarter of an 


hour for herself. She says that it is her mother’s birthday, and 
that she wishes to explain how she plans to live in the future. A 
great change had taken place in the last few months; she had 
cursed every one, even her own people. “I cursed religion; 1 


113 


cursed love! 1 would not believe—and now belief is restored in 
me. I now know that I must bear what has been imposed on me, 
and I am ready to bear it. I wish to be quite patient. There is 
only one thing I can’t do—I cannot return to my people! There- 
fore | beg you to tell my husband I am incurable. He should not 
wait for me and keep the large home. I can never return. I 
wish to stay here. I especially beg that none of my people come 
to see me, and that they no longer send me anything from home. 
I wish to demand everything I may, right here; the smallest and 
the largest, whatever I need. I wish to have the most implicit 
faith in you: only they should send nothing from home, if they 
do not wish to excite me. Now I realize I am sick and that J 
was already insane in the sanitarium; but just for this reason 
I can never see my people again. I shall surely not take my 
life. During the whole period of my disease, I often wished to 
do so, but it was as if an unseen hand prevented it. Ten years 
ago I had already passed through such a stage of this illness— 
but I was always eccentric as a child, peculiar. Because of this, 
it is clear that I am incurable: For this reason, I wish to have 
no communication with my people. Please implore them not to 
send me anything from home. (The day before she became 
violently excited over some caviar sent by her husband.) There 
are a few things I should like them still to send me, because it 
is necessary for my peace. Of course, now I cannot say if I 
shall be of a like mind in a few days, but I wish the Bible my 
mother gave me, my song book, and letters and documents that 
pertain to my adopted daughter, beside a few photographs.” 

Then she narrates much of her own life, and how she met 
her adopted daughter. She shows interest in others, inquires 
about people in her neighborhood, about their circumstances, 
about the family of Director L. She begs for work continually, 
wishing to take part in the housework. When this is allowed, 
she does everything with great care. In the same way, she 
mends the laundry or clothes and believes that this diverts her 
mind a bit, at any rate. Asks to attend services and wishes her 
jewelry, as she would like “to dress up for Sunday.” At church 
she is very restless, weeps and moans, but cannot be persuaded 
to leave. Is satisfied with the sermon. 

For years she constantly sought a way of taking her life. She 


114 


once put the new silver clasp of her workbag in milk to obtain 
verdigris. But she never had the courage to carry out her plan, 
and threw away the metal while she was taking a walk. Now 
such thoughts have been conquered. She works with diligence 
and care, dresses herself and combs her hair neatly, writes serious 
articles. She takes interest in her surroundings and has a clear, 
intell'gent opinion of them. 

She asks for five sheets of paper to write a long-planned letter 
home. She wishes it to reach her husband on her birthday. She 
writes during one day: 

“My dear, good Ernst: The moment has finally come when, 
after weeks of delay, I can write you. It is just three years 
since I was brought to this house, and indeed, an eternity lies in 
these three years—or has the whole time not existed? As far as 
I am concerned, I do not know. Director L. will have informed 
you of the change in my condition much better than I could. It 
was my inmost longing to see you and talk to you on my birthday; 
to tell you that you must give up your wish and the aforemen,. 
tioned hope in regard to my return to my accustomed duties as 
housekeeper and mother. 

“TI knew from the first day that I could not be saved here; 
that I am irretrievably lost for you, the children (she had only 
an adopted daughter), for all of you. Only a few days ago, I had 
the desire to tell in the most detailed manner all that has hap- 
pened to me since the day of our parting—especially since Febru- 
ary 4—and on the birthday of our dear, sainted mother. You 
said to me in that inhumanly sad hour of your visit, ‘If you but 
knew how unhappy we are!’ I know it to an extent you cannot 
measure. My state of mind during your single visit—I can’t 
understand how I lived through it—has become clear to me 
through the remarks you were able to make in your great excite- 
ment. I merely repeated your own radical, pessimistic, material- 
istic theories, which you often expressed, the destructive ideas 
that must lead to the downfall of church, state, and family. 

“Today I know full well how unhappy these remarks made 
you: I know it to a degree you can’t imagine. The fact that 1 
know and live is the reason for my condition, because of which 
I can never be outside this house and away from the care of the 
director. Until recently, it seemed to me so unnatural; today 


115 


I have given myself over in blind confidence, with body and soul, 
as I could only give myself up to God. . . . Dear, dear 
Heavenly Father, whose bounty shows itself beyond all human 
comprehension, have compassion on my husband’s deathless soul; 
support him as You do me; conquer him so that, after this infinite 
misfortune I have brought him, he may go forth not as a broken 
man, lacking in self-control, but as a harmonious, strong-willed, 
clear, purified personality. Grant him this for love of me, be- 
cause he knows I pray night and day on my knees that he master 
the passion whose slave he was. Bless him with the peace for 
which he searches but never finds.” 


On the afternoon of the same day she wrote: “Three years 
ago today, at this time, during this very hour, I entered this 
house. . . . For you, for my child, for my sisters and broth- 
ers, 1 am and I remain irretrievably lost. I am dead to you. No 
power on earth can force me to return to you, to step over the 
threshold of our house, and if you wished to flee far away into 
a wilderness with me, you would have to lead me back from there 
to this place, in the very first hour. During your single visit, you 
saw me in the condition of mind in which I have been for three 
years. Itis just six weeks—lI know the hour, because I suddenly 
had to wipe my eyes. I lay on the floor with covered face for 
days and cried out, ‘I cannot stand the sight!’ Truth in her cold, 
icy, unapproachable severity, or this vision, fanned by an ever 
sweeter ray of a superhuman, inconceivable body—it was God. 
Until this moment, my ego had been changed; my whole being 
appeared to me objectively. I thought, spoke, acted, without 
will. In part, I appeared to be an automaton, in part, a sudden 
and entirely comprehensible personality: I as myself, and still 
quite strange and totally new to myself. On February 4, the 
band of my tongue was loosed. What opened the way to me for 
this was the prayer of our pious mother. Since that hour she is 
again with me. 

“T am not what I am; I am not what I was; and I do not 
know what I am to be. So—briefly—only this which I no longer 
can suppress. Believe me, my pen is dipped in my heart’s blood, 
and every word has come from the greatest soul torment. From 
your single visit and the superhuman torture it caused me, only 
the memory of these words remain, ‘If you but knew how unhappy 


116 


we are!’ The only way out of this labyrinth is called resigna- 
tion to the holy, inscrutable will. I could not write this yesterday” 
and dare not write today, as I do not believe it myself, nor can’ 
I grasp it. I feel, my only, good sweetheart, that when I proceed, 
I must speak in accustomed and yet new language; because I feel: 
that I have told you all today in these few words, everything that” 
I still had to say; because I am not the person I was, I was not’ 
the personI am. . . . As the result of the limitless struggle: 
for true knowledge, so difficult for a woman, my intellectual’ 
and inner powers are so absorbed for the present that I cannot 
proceed further than to lay my head on your shoulder. . 
“T do not know if Toni (the adopted daughter) has kept the 
fascinating charm she had as a child, but I know exactly the 
characteristics of her disposition, as I have watched her closely” 
with infinite pains for three years. The blind love which held me} 
then has given way to an objective point of view, under which) 
love once suffered. This is her disposition: a happy, contented © 
being with clear understanding and a talent for practical things. 5 
How far at that time heart and intelligence were present was ” 
not easy to determine.” 
Even much more deeply affects us the will she made a few | 
days later: “In case of my sudden death, the following are my 
wishes: I know my dear Ernst will agree with everything, though | 
I realize that I have no independent rights in the disposal of my © 
legacies. (The patient is the wife of an important official of the © 
court of law.) I know his love for me is so great that he must | 
heed the last sighs of his longing wife and not hesitate a moment © 
to carry out my wishes. q 
To be received on May 22. | 
Here follow the names of four persons who are each to receive | 
either one or two thousand dollars and wearing apparel. . 
Give the William Infirmary $1,000, as I have Jearned in this — 
place that reason is the highest good, and those poor creatures | 
who live there are most in need of help. 
My nurse Marie, who takes such good care of me, $50. Our 
three faithful servants, each $50 (here follow the names). 
I wish to send $2,000 to England (the birthplace of her 
adopted daughter) and every year for Director L. a sufficient | 
sum to take care of a patient without means. 


3 
t 












eS ee ee 





117 


The things I have here are to be distributed by Miss W. (head 
nurse), who has been to me mother, sister, and friend in one. 
She herself should receive the fur collar and muff to match, 
which are at home. Clara receives my new winter dress, coat, 
muff, and hat. Martha A. gets the jewelry Clara has taken 
care of. 

The aunts (names follow) and the assistant physician some 
pretty remembrance from among our things. Miss H. the mosaic 
brooch. 

I beg Director L. to accept, as a slight token of my love and 
gratitude, the paintings in our drawing room, The Last Supper, 
The Washing of the Feet, and my favorite Madonna over the 
mantelpiece. 

The older of the Director’s daughters is to receive my watch 
with the gold chain, the younger my brooches. 

Various articles of my wardrobe, all useless freight, should 
be sold. | 

For Toni, the silver and table ware remain; only the following 
articles on her eighteenth birthday, with the fullest truth.” 

After she made out the will, the patient not only cut off all 
connection and interest with the world, but she suffered mental 
death. It is really appalling how quickly she went to pieces. 
Only two weeks after handing over the document, the patient, who 
regarded herself up till now “a philosopher” who, as she expressed 
it “can speak only the language of Plato, Kant, Fichte, and 
Schelling,” sits in corners, grows very restless, is totally careless 
of her appearance, and wishes only to sleep on the floor. At 
night she howls like an animal, mistreats in a brutal manner her 
own body, is frightfully unclean, refuses food, eats, however, 
her excrements, begins to rave, to destroy. With all this she is 
conscious and observant even of trifles. During the following 
months, the characteristic deterioration goes to its final stages, 
and the—once emotionally and intellectually so richly gifted—de- 
plorable creature, sunk to the level of an animal, is still vegeta- 
ting in the asylum. And since that time have already passed 
over thirty-six years! 

In another will * we observe the joking, sarcastic manner, in 
which the patient sneers at the pale face of death. Noteworthy 





* Case XIII in paper.” 


— = 


2 


118 


is his strength of character, the icy peace and contempt for death, 


the stoicism with which our patient awaits the ‘Scytheman,” “ 


‘{ 
i \ 


255 


well as his mighty, we call it, negative affect. 

“I have already expressed myself in regard to the momet 
when Mr. Scytheman should draw near me. Just as many ; 
big and many a less important man has passed me by with rough 
tempo during the last year, I wish you (the doctor) through t 
paper to make note that it is not necessary for anybody—perha 
a relative or someone else—to let himself be called to the institu 
tion when I am going to expire or have already become a corpse; 


Furthermore, it is eo ipso to desist from flowers and wreaths, 
candies or benefactions. Pompous funeral, as well as last words 
of praise for posterity, through churchly or other professionals 
is hereby courteously and thankfully declined by my worthy 


person. Because one who has made experiences in such a way 


as I, does no more need at his death—if there really is such 















might have done in life, or failed to do. You are not to a 
these my plain sentences as bier talk or boyish prattle, but as the 
determined will of a man with a sone character ; and when if 
above. Hegeven if ne are not as yet familiar with this, let 
me add that it is not necessary for any one to wear outward, 
visible signs of mourning or to shed tears of pity. Respectfully, 
UR Oia 

This patient was fourteen years in the institution and has 
manifested the whole time the very symptoms of a chronic for n 
of catatonia. The above-reprinted will was made one year before 
the patient’s death. 

There is also an interesting letter written eight years earlier: 
Ultimo, i 1901. Gentlemen: Diba I have often told 









Woerth, es played a mean joke on me by announcing, a 
the attendant W. with the green cap, a visit from my brother, 
On account of scientific interest, I went in my elegant dress clothes 
to the so-called visitors’ room, where a young man with long 
ears and a thick belly and stupid face awaited me. Allow me to 


119 


submit his characteristics for your information: Said man was 
born in 1870 in Ziegelhausen, District Hurenberg + (meaning 
Heidelberg!) on the Neckar, under the name of ‘“Benkart.t” 
Here follow statements and cynical remarks, showing, however, 
good memory. For example, “My parents croaked miserably, 
when I had scarcely been weaned, in the night from Shrove Tues- 
day to Ash Wednesday! I was eleven months old at the time 
and was said to have no real nor false tooth in my mouth.” 

Still another—‘‘was well-educated, talented. Since her hus- 
band has known her, the patient has never kept her appointments. 
Knew no limit in expenditures; was mostly extravagant, but also 
stingy. As regards the latter, she always emphasized her fru- 
gality. She seldom kept her promises, her word. Even in the so- 
called well days she spent weeks at the piano, then again for 
months she did not touch the instrument. The warmest friend- 
ships changed to the greatest animosity. Religious, social, poli- 
tical convictions, sympathies and antipathies, altered every 
moment. She would sit with her books for months, but then 
tread nothing at all. It was the same with housekeeping, needle- 
work, and so on. She could exercise extraordinary control over 
herself only to attain her end. A passion, for instance, to 
‘change the furniture of the room. Makes known this wish to. 
day, tomorrow, that; then forgets the latter and once more desires 
the opposite. She herself found it stimulating to express herself 
In paradoxes concerning her condition. Always protests her 
obedience and acknowledges her weakness and_ excitability. 
-(Anamnesis of the brother, Chief General Medical Consultant*D.) 
In the asylum, where the patient came in 1872 at the age of 
twenty-seven, the condition at first remained unchanged. “In 
her letters to her husband, circumspect, avoided her pet theories; 
‘but in writing to her children, confused, senseless. Yet never 
forgot a birthday and sent money as a gift. Her mental weak- 
ness, meanwhile, showed itself in her contentment with her posi- 
tion, which did not rest upon self-knowledge, in her slight natural 
interest in her family, and in her meaningless wishes, the non- 
fulfillment of which she accepts as indifferently as their gratifi- 
cation. In her favorite political-philosophical conversations there 








+ Hure means whore. 
+ Means bastard. 


120 


is noticeable at once her astonishing familiarity with historical, 
literary, and social matters; yet the ideas are so miscellaneous and 
loosely bound, most of them so one-sidedly exaggerated, many alse 
falsely and phantastically conceived, that connection no longer 
exists among them. Thus she springs from one thing to another, 
mixes together the strangest, quite incomprehensible things. 
At the same time, she puts immediately, however, into every 
theme, definite representations and manifestations, so that not 
the same meaning but the identical sound of words is always te 
be heard. Also her seclusiveness as regards the external world 
contrasts with the lively need to make herself companionable, 
Some years later we read: Makes notes on works read; adds het 
phantasies to them. When she goes to the city, spends more 
money than had been previously determined. Visual images of 
a phantastic sort. If she looks at the clouds or a wall, angels 
appear there. Expresses numberless wishes, which she speedily 
forgets. She becomes, however, violent and excited if anyone 
directly refuses her. Her thoughts—have worked earlier 
unrestrained, against her will (it seemed “as if a mill wheel were 
in my head; everything whirled about in a confused mass”) 
while she can now control herself, and she need not if 
she may not, think this or that. In 1886 we read: Why are you 
here? “In order to become familiar with all the arrangements 
of this excellent sanitarium and then to carry these to other 
institutions and other countries.” Speaks hereby with a superiot 
air, looking down from above. Asserts—which is not true— 
that her husband has permitted her to go to a less important 
physician and a less advanced sanitarium near Paris. Begs me 
(the doctor) for advice and recommendation. Writes then— 
without foundation—to her husband that I have approved of het 
plans and recommended her to visit, for two years each, different 
institutions of Europe, in Paris, Madrid, Rome, and Vienna 
Speaks frequently of the fact that she will soon be at the end 
of her study of the sanitarium here. Intimates thereby that she 
is that person who has to give orders here. Very confused and 
unintelligible in her speech aside from this. In 1888, we read} 
Totally transformed. Regulates her time with painful exactitude 
in the same fashion. Thus she often finds out from me whether 
it would be all right for her to go walking for such and such a 


121 


length of time, and the like. Rarely speaks for some minutes 
without becoming totally confused. Despite this, she adapts her- 
self to the partner when she accompanies him at the piano. In 
1895, it is noted: Confused, unclean; marked hallucinations. 
Mostly excited, perverse, or again, motionless and dumb. Occa- 
sionally, however, during a visit very neat. Informs herself of 
everything, shows a remarkable memory for former patients and 
events. Sometimes also relates much from society. Toward a 
visitor, dignified but friendly; soon sends her away: “It is only 
an old passing acquaintance.” Prattles meanwhile to the nurse 
a great deal about her close relations with the lady. Immediately 
afterward confused. Does not wash herself; stands there un- 
clothed; screams frightfully. Brought to the unquiet ward, she 
conducts herself like a lady. She dresses herself, goes walking, 
is friendly and reasonable She knows exactly everything in the 
institution, informs herself of this and that. Much lively interest 
in the question of the toilet. Would like to wear only silk 
gowns, new hats, and so on. But wants as a birthday gift “not 
to have to bathe.” In 1898, it was noticed: Begs for forgiveness 
for all unpleasantnesses which she had caused. Asks all sorts of 
questions of her housemates and shows thereby that she observes 
well her surroundings. Tells of persons who were here twenty 
years ago! While earlier her letters were confused only in con- 
tent, now the style also is faulty. In 1900, the record reads: 
Wants Briefbogen (sheets of paper). Instructs the nurse that 
she should not say Bogen (bow). This would be to shoot with; 
she should ask for Briefpapier (letter paper). In 1907, we read: 
Extreme stereotypy in posture and manner. Stiff, almost ac- 
curately measured movements. Nevertheless, by continuous 
questioning and in spite of her almost purely mechanical responses, 
a fair amount of details can be brought out in regard to her 
past and her condition. In the course of the interview, however, 
she becomes more confused and then rambles on. It was noted 
in 1908: Frequently puts upon the table a drawer with carefully 
sorted yarn and needles in order “‘to air them.” She complains 
that at home they have no soul toward her. This word she does 
not understand at all; what is it in French? Can it be translated 
by ame? In 1911, we read, “confused, hallucinates more. Stands 


122 


there naked; as for the rest, mostly apathetic, automatic, indi 
ferent, rigid.” | 

The last patient of whom we will still give a quite brief 
account was a highly gifted child, hale and hearty in body.” 
Learned readily, especially languages. Is a painter by calling | 
and very well-endowed artistically. Very alert mentally, unusu- 
ally clear and deliberate in thought and resolute in will. In the 
year 1897, the death of a married sister made a great impression” 
upon the patient. Later concern over the establishment of an” 
independent activity, and at the same time, for her brother, whose 
betrothed was deaf; also an injury to the knee, which compelled” 
the patient to stop her work, caused a severe depression. Christ- 
mas 1901, the patient attracted the attention of her family by her 
strange letters. Her father, general medical consultant, went 
to her and found her in a melancholy frame of mind. She in-7 
sisted that she was a wicked person and had brought misfortune i 
upon her family. At home she became worse. On being ad- 
mitted to the clinic for the insane in April, 1902, the patient was” 
completely oriented and gave information promptly. Expres-— 
sion of her face tense. She was not sick. Admitted, however, - 
that she had reproached herself and had thoughts of suicide.” 
Crying spells also had appeared in the beginning of the year. 
The day after she sits there rigid. Longs for home: “Have pity 
on me!” In the days following she repeats again and again 
that she is well. She had deceived her parents so that they had 
formed the idea that she was ill. Concerns herself about money; 
wants to be put into the third class. | 

May. Attempts at strangling; abstains from food for days. 
June: Stops suddenly while speaking and is silent. August: Hal- 
lucinations. Sometimes laughs out loudly. Does not answer, | 
but says once to her mother that she is not at all herself. October: 
Forces her way out, because she believes that something frightful 
is happening to her family. Is always unsteadily clutching at the 
nurse’s throat. Breaks the window panes. 


1903. Attempts to hang herself. Then come times in which 
the patient is accessible, takes pleasure in nature on her walks, 
shows interest in letters and messages; soon, however, she lies 
there apathetic and commits violent, impulsive actions. Treats 
her nurses like servants. 


Led 


1904. Speaks French, English, and other languages. Springs 
at the throat of any one entering. Human beings are beef. 
Makes grimaces. Eats sand. Takes her meals with her hand, 
refusing the spoon. At times terribly violent. 

1905. Reads journals with interest ; then tears them to pieces. 
Beats her head hard for ten minutes upon the floor. Then very 
still; points, groaning, to her head. Still gives thanks at meals. 
Gives her hand in friendly greeting on a birthday. Glad to re- 
ceive letters, but quite wild afterwards. Many times warns those 
about to be on their guard toward her. “Look out for me. I 
am very bad.’’ Very unclean. A stereotyped meaningless phrase 
to every question. 

March. Clearer, grateful, friendly. Knows her mother when 
the latter visits her, but gives her no answer. Very violent toward 
a fellow patient, who, to be sure, had irritated her. Said later, 
“T slipped from my role.” 

1906. Sits there inactive. Without shame. Shows no in- 
terest in her surroundings. Makes shrill and quavering noises 
to herself for hours. 

September. Recognizes immediately her completely demented 
sister, calling her by her right name. Strives to stay near her 
permanently and talks to her—it is true, in a totally confused 
manner. Still has a passable interest in her music. 

1908. At times still quiet. Gives her hand with exaggerated 
politeness. Mostly noisy, violent. Utters senseless words until 
hoarse. Unclean in her personal habits. 

1909. End state. Has plucked out her hair. 


sk 


A psychiatrist seldom has the opportunity to receive upon 
the childhood of a patient reliable reports from which he may 
prove that characteristics regarded by the relatives as bad habits, 
moral errors, nervousness, and psychopathy, are in reality har- 
bingers of a psychosis resulting in deterioration. Having such 
records, however, we can show at which moment intrapsychic dis- 
harmonies and an inner laceration of the personality are plainly 
to be noted. In the following case, this was possible because 
the patient’s father, a school principal, had kept upon his son a 
daily diary, from which (paper ° page 42) we quote an abstract : 


124 ' 

“Birth from six to a quarter past nine in the afternoon of» 
November 27, 1881. First tooth in his seventh month. f 
June, 1882: During vaccination feverish. / 


November 25: First walked by himself. : 


Summer, 1883: Much diarrhea, often lasting a long time.” 
Middle of November, four days’ fever. End of December, afters 
eating lentils the child had upset stomach. Four days in bed. 
Faints, with twitchings of whole body. Lasted ten minutes. Un-7 
conscious half an hour. Began to speak at an early age. Letter 
r was difficult for him. \ 

March, 1884: Can speak 7 well. May. Walks of several 
hours’ duration. Strong and Salhi but a little stubborn. Talks 
of himself in the third person as “Johnnie” or “he.” August: 
Grows much, becomes thin and pale. November: Healthy and 
strong. : 

January, 1885: Mumps. April: Often out of humor, stub-~ 
born, and naughty. November: No longer stubborn; is friendly, © 
cheerful. Speaks fluently, observes carefully. Very clever and™ 
sensible. Yields in quarrels. . 

May, 1886: Mumps again on both sides. A slight fever. 
August: During his vacation ate plenty of fruit. Once, spells ~ 
without premonitory signs. After the attack, speechless; then 
slept. When awake, good behavior; played and ran about. 
October: Sings, manifesting a good ear. November: Tall for his 
age. A bit pale. Nimble and skillful with his hands. Good- 
hearted. Quieter; more earnest in disposition. A little round- | 

shouldered. 24th: Yesterday ate fresh cakes. This morning, 
spells. No control over the bowels. Worms suspected but not 
found. | 

February, 1887: Lively, grows very much. Active and sure 
in all his movements. April: Takes long walks. Is still un-— 
mannerly. Grabs the bread and butter with all his ten fingers. 


| 
7 


October: Goes to school for the first time, gladly and proudly. © 

December : First in school. 

April, 1888: Gymnasium. Shy. Spirit of contradiction. Hard 
to persuade. For example, cannot be made to take off his cap. 
Does his lessons. Glad when he has finished. Healthy and large 
for his age. 


125 


July: Cries easily and keeps to himself when something does 
not suit him. 

November 16: This morning, while dressing, has a mild at- 
tack of stomach cramps. (Day before had eaten much other fruit 
and unripe grapes mixed together.) A sort of fainting without 
convulsions ; was not quite unconscious. Otherwise healthy. 122 
Cm. Works hard at school. One of the first students. 

July, 1889: A bit awkward. Gets spots on himself while 
eating. Many inkspots. Likes to find fault. Begrudges every- 
body everything. Truthful; diligent; sensible. 

July, 1890: A bit rude and stubborn. otherwise clever. 

May 1891: Cheerful and healthy. 133 Cm. tall. Favorite 
recreation, the atlas. 

July: Famous expert in beetles. Coleopterist. 

November: Strong; sometimes awkward. Very good stu- 
dent. Sits often, however, with his mouth open. 

February, 1892: Cheerful, good-natured. Superficial in writ- 
ten lessons. 

May: Second in school. Learns very easily. 

November: Practices piano a bit; does not care for it. Since 
October in quarta. Now eighth in class. 

October, 1893: In under-third. 

November, 1894: Works diligently. Mathematics difficult for 
him.* Piano playing given up. Still reserved and shy in social 
intercourse. Likes to look neat. Not very kind and polite, but 
otherwise good. April, 1895: In spite of private lessons in 
mathematics, weak. Ill-humored. Glum disposition. October: 
In secunda. Sits much. Drudges. His favorite recreation, 
geographical cards. 

April, 1896: Set back half a year. Begins secunda again. 
Thin, but looks well. Likes to be alone. Not sure of himself 
with strangers. Almost shy. Sensitive, awkward in working; 
wishes no help. Diligent. 

July: Embarrassed before strangers. Contradictory. Disin- 
clined to render any service in the household. Likes to be alone. 
Has nosebleed frequently during autumn holidays. 

November: Very diligent. Often works until late at night. 





* Some catatonics excel even in mathematics. 


126 


January, 1897: Exhausted. Eats little. Nervous. Often re- 
tires to be alone. Upper second class. Very shy—no admonish- 
ing helps. Runs away, calling them “reproaches.” Gets along 
better with his brother. 

May, 1898: Healthy, diligent, but still has idiosyncracies and 
peculiarities. In winter his voice changed. Has a kind of 
stuttering; now better. Senior class. 

April, 1899: Among the first in school. Tutored others for 
a while. Great change. 

November: The diligence has greatly waned. Lax, lazy, stub- 
born. Is a source of much anger and worry to me. 

January, 1900: No better. As if possessed about geographical 
cards. Seeks to be alone. Is often ugly. 

March: Did not pass examinations. All but mathematics 
satisfactory. 

April: Sent to the college at Berlin. Absolutely refused to 
write his first essay and came to class without it. Suspended for 
this. Came for some months in a sanitarium. Then employed 
by a lawyer. Did very well. 

On April 27, he visited the grave of an uncle of whom he was 
particularly fond. Then he attended a concert. The following 
night intense regret, with crazed religious ideas. Because of 
these, he had to be placed in an asylum. With no improvement, 
the psychic destruction proceeds very rapidly and in the following 
twelve years the patient shows all the specific symptoms of an 
unusually severe catatonic terminal state. 


* 


Documents such as these, form the material for proof of the 
author’s theses. We must limit ourselves here to what has been 
offered above, but even these short outlines will have shown the 
reader what is contained in this masterly written book of realism 
and truth. This volume will also tell us that if some one wishes to 
portray abnormal emotional conditions, he ought to pay attention 
to these all too true pictures of the pangs of the soul, to this 
narration of the most common mental disease. For, with Field- 
ing,* we likewise decree: The work of a poet who has not gazed 
behind the deformed scenes of nature is not worth reading. 





* Great English novelist, 20, IV, 1707-8, X, 1753. 


——_— + ¢—______ 


ate eee 


— * 
le a 


127 


Before me lies the third volume of the Monatschrift fiir 
Criminalpsychologie und Reform des Strafgesetzes (Monthly 
Journal of Criminal Psychology and Reform of the Penal Code) 
published by the distinguished psychiatrist Aschaffenburg and the 
illustrious modern jurists and criminologists Von Lilienthal and 
Von Liszt. This volume contains an article by Longard on 
“Diminished Responsibility.” Longard was for fifteen years 
prison physician in Cologne and is—as every prison physician in 
Germany must be a psychiatrist—a well-trained specialist. Long- 
ard has been occupied later during ten years as court expert and 
has enriched our literature through valuable contributions from 
the field of forensic psychiatry. This is not the place to discuss 
Longard’s views and his propositions. Instead, I will cite a case 
which abundantly shows how necessary it is to know the entire 
life history of a person, and what in it must carry such absolute 
conviction that even the observation of experts, in so far as it 
extends only over a given period of time, does not suffice to explain 
the case and to judge it fairly. Besides, it has already been 
emphasized repeatedly that we have no right to draw conclusions 
from one phase of the life of the individual to be examined; that 
our observation must go back into the earliest period of the 
patient’s life. Yet we had no occasion to support our assertions 
by a convincing concrete example, which may be cited here literally 
from Longard: 


“IT saw a man who had murdered his wife and for this was 
condemned to death. Since he did not live in my district, I could 
not take part in his trial. During the preliminary inquiry, no 
doubt arose as to the responsibility of the doer of the deed, and 
even the medical investigations were also unable to establish in 
the man a psychic deviation from the normal. 

“Nevertheless, in the course of the main trial, as happens in 
similar processes almost without exception, the question as to the 
psychic state of the accused was again considered. The man was 
not observed for a very long time. The experts, however, de- 
clared that the impressions which they had obtained in the pre- 
liminary examinations and during the legal trial did not awaken 
any doubt as to the responsibility and the normal psychic condition 
of the man. The court also gained the same impression. But 
since the deed was carried out with extraordinary brutality, and 


128 


nothing spoke for a mitigation of the punishment, the arraigned 
was condemned to death and sent back to jail. Scarcely had he 
returned from the courtroom to his cell, when, as always, he 
greedily ate his meal and showed himself stupendously dull and 
emotionless, asserting that they would behead him that day directly 
after his supper. When my attention was called to this attitude, 
which so definitely contrasted with his situation, I began, as the 


a “_j aa mg ins 


prison physician, to observe this man and convinced myself that | 


I had before me an unusually indolent, feebleminded individual. 
Thanks to further investigations, we found out that already in his 
native city and also during the serving of a term in prison this 
man had behaved very strangely, and that in his fifteenth year 
he had suffered from insanity with attacks of fury, which had 
been diagnosed at that time as dementia praecox. I imparted my 
information to the court authorities and sent in a detailed opinion. 
Sentence accordingly was not carried out. 


“Dementia praecox,’—therefore catatonia—Longard says, 
“often even at the first outbreak of the disease already destroys 
the entire social personality of the individual concerned and leads 
to an asocial conduct, which, according to its nature, is diametri- 
cally opposed to the earlier behavior. For this reason, we are by 
no means entitled, when we give our decision upon the doer, to 
make it dependent upon the committed deed, as such, or upon the 
circumstances under which it was performed, and just as little 
upon the motives which have driven the culprit to the act: we 
must not overestimate these things even then when the deed was 
carried outt with the greatest skill and in a marvelously conse- 
quent manner. 

“The public, no circle excepted, like the press, demands ven- 
geance if an event occurs which furnishes material for sen- 
sational reports and notices. All are dissatisfied, speak of vio- 
lence being done to the righteous conscience in general, and they 
begin often to suspect if a person is acquitted on the ground of 
—it is assumed ‘pretended’—pathological psychic conditions. 
If the doer of the deed is condemned, however, then the 
same people and the same newspapers which called previously for 
revenge begin regularly, so far as a morbid sign becomes evident, 
to argue that, properly speaking, it was at least a detestable 
thing to punish the man, since it appears as plain as day that 


1A TRU aA DUR aus Uy mayest ce 


insanity had driven him upon the path of crime. These are oc- 
currences which we meet at every step. In the case of an ordi- 
nary criminal, if there are no special considerations at hand, par- 
ticularly of a personal sort, nobody cares to ask what fate has 
been allotted to this individual lawbreaker. In general the public 
is even more at ease hearing that the delict was the outcome ot 
an abnormal condition, that the perpetrator is freed from legal 
accountability and has been rendered harmless in some other way. 
Consequently, the judge, as well as the expert, must manifest 
great firmness and unyielding strength of character in order not 
to succumb to momentary public opinion but to preserve that 
objectivity with which he is accustomed to pass sentence upon 
deeds and persons in cases which concern the average man.” 


New York, July 24, 1924. 


VW The die is cast in ourcases . . . But—a life cataclysm, an 
elemental misfortune is any psychic disease, and never a shame, 
never a disgrace, never an intended misdemeanor, never a trans- 
gression against the law. Deeds of mentally sick persons may, in 
their consequences, have the most pernicious effects; despite this, 
no Legislator will acknowledge them as a crime. 


1. 


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130 
LITERATURE CITED. 


Own Works 


Lekarskie (Polish) 1903 No. 9. 


Urstein M. Prognosis of Dementia paralytica Nowiny © 


Comparative Psychiatry. Centralblatt £. Ner-_ 
ven. u. Psych. 1906 No. 8. Medycyna 7 


(Polish) 1907. 


der Gegenwart. 1906 No. 9. 


Clinic and Therapy in Central Asia. Therapie ~ 


Dementia praecox. Allg. Zeit. f. Psych. 1908 © 


p. 479. 


Dementia praecox and its relation to mamnic- — 
depressive insanity. A clinical study. 


Berlin 1909 Pp. 372. 


Manic-depressive insanity as phase of Cata- 
tonia. A Monograph. Berlin 1912. Pp. 650. 


Newest researches in medicine and biology. — 


Gegenwart 1911 No. 9-14. 


Circular Insanity as phasis of Catatonia. Wien. — 


Klin. Wochenschr. 1912 No. 33. 
Catatonia (Polish) Medycyna 1913. 


Causes and Nature of Catatonia. Medycyna — 


(Polish) 1913. 

Late forms of Catatonia. A clinical study. 
Berlin 1913. Pp. 459. 

Relations between the Gonads and other Glands 
with Internal Secretion. Wien. Klin. Woch. 
LOLS eNovi3a 


Abderhalden’s Method and Glandular Correla- — 
tions. Gazeta Lekarska (Polish) 1913 


No. 35-37. 
Latest Developments in Medicine. Gazeta 
Lekarska 1913 No. 40-46. 


Catatonia under the picture of Psychopathy. — 


A Monograph. Berlin 1922 Pp. 464. 


131 


16. Urstein M. E. Niewiadomski in the light of a psychiatrist. 
Warsaw (Polish) 1923. 

17. ——————._ The Epileptic Forms of Catatonia. Read be- 
fore the Psychiatrical Society Wards’ Island, 
15th January, 1924. 

18. ——————— Character and Treatment of the Epileptic 
Forms of Catatonia. Read in the Annual 
Meeting of the Chicago Neurological Society 
the 17th May, 1924. 


OTHER AUTHORS 


*7 Abecrombie. Inquiry into the Intellectual Powers. 7th 
Edition page 158. 

86 Alzheimer. Cited after Kraepelin. 

87 Anton. Ueber krankhafte moralische Abartung im kin- 
desalter. Halle 1910. | 

42 Bastian. On Aphasia and other Speech Defects. Trans- 
lated by M. Urstein, Leipzig 1902 page 213. 

*8 Bastian. Case XCVII. 

58 Bernard. De 1’ Aphasie 1885 p. 119. 

88 Bischoff. Text-book of Legal Psychiatry 1912 p. 33. 

°° Bleuler. Text-book of Psychiatry, English 1924. 

44 Charcot. Diseases of the Nervous System. 

*5 Charcot. Lectures on Aphasia 1883. 

40 Dickhoff. Allg. Z. f. Psych. 1898 p. 215. 

48 Edgreen. Brit. med. Journ. 1894 p. 1442. 

“ Balret. Dict. Encycl..d. Sciences Méd. Vol. V. p. 620. 

4 Finkelburg. Cited after Bernard |. c. p. 119. 

82 Gowers. Diagnosis of Dis. of the Brain. 2nd Edition p. 133. 

51 Grasset. Montpelier Méd. Vol. XL. 

20 Hoeven Vander. Allg. Z. £. Psych. 1922 p. 228. 

41 H[enneberg. Charite Annalen 1900 p. 424. 

21 Hoffmann. Nachkommenschaft bei endogenen Psychosen 
Berlin 1921. 

19 Hess. Heboidophrenie. Allg. Z. f. Ps. 1906 p. 594. 

22 Kahlbaum. Heboidophrenie Allg. Z. f. Ps. Vol. 46 p. 461. 

5° Knoblauch. Brain Vol. XII p. 317. 


132 


3 Kraepelin. Text-book 7th Ed. Vol. II p. 640. 

24 Kretschmer. Korperbau und Character. 

57 Lichtheim. Brain 1885 p. 461. 

7° Longard. Allg. Z. f. Ps. 1898 p. 88. 

26 Meggendorfer. Z. f. d. ges. Neurol. u. Psych. 1921 p. 208. 

*UMosiey Allo Zet eis. Poy, 

5> Proust. Arch. Gen. de Méd. 1866. 

** Rauminger. Psych-Neurol. Wochenschr. 1909-1910 p. 417. 

ee Redhch, SMe Are ee ep Obe 

30 Rinderknecht. Kriminelle Heboide Z. f. d. ges. Neurol. 
u. Psych. 1920 p. 35. 

Risch sic loa ere ies) woUe pero, 

82 Stelzner. Allg. Z. f. Ps. 1914 p. 60. 

88 Strauss. Archiv f. Kriminalanthropologie 1914 p, 111. 

*° Trousseau. Lectures translated by Bazire Vol 1 p. 267. 

87 Wenger-Kunz. Zuricher Dissertation 1919. 

56 Will’e. Disorders of Speech p. 117. 

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